Economic evaluation
illness
The economic evaluation involves cost-effectiveness analysis of the intervention from both the health system and societal perspectives. The key outcome measure will be Quality Adjusted Life Years (QALY), which will be estimated using the utility values (SF-6D) derived from the SF-36 survey form. Costs being assessed include both direct medical and non-medical costs and indirect (lost days of productivity) costs associated with the intervention. These are be based on information on staff inputs by duration and type and resource use collected during the study. Any additional “knock-on” effect on hospital admissions or outpatient service use is being quantified and costed for each study participant. We are calculating direct costs to the health service and patients from health facility records, project financial accounts, and participant responses to a survey including questions on health service use and spending. These analyses will be based on updated estimates for health facility costs and personal costs Personal costs to individuals will be collected as part of the questionnaire administered to study participants at nine years. These include transportation costs and out-of-pocket spending for health services use, especially for medications and will capture how the individual financed these costs (e.g., borrowing, asset sales, dis-savings). Any indirect costs to patients arising from being absent from work due to the intervention or illness are also being estimated. Savings from lowered health service use associated with the intervention are subtracted from intervention costs to derive incremental costs at the 9-year mark.