How to get more out of every health care penny

A new course in health economics at the University of Bergen provides the health care workers with the opportunity to offer more effective help to patients.

Ph.d. candidate Hamidah Hussain from Pakistan and master student Chukwuemeka S. Agbo from Nigeria at the first course in health economics at the Centre for International Health in spring 2014.
ANALYSING COSTS AND BENEFITS: Doctoral student Hamidah Hussain from Pakistan and master student Chukwuemeka S. Agbo from Nigeria were among the participants in the first course in health economics at the Centre for International Health in spring 2014.
Eivind Senneset

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Beginning in spring 2014, the Centre for International Health (CIH) has offered a course within health economics, entitled Applied Economic Evaluation in Health Care, to master’s and doctoral degree students. The Centre is one of a few academic communities in Europe to offer this type of course.

“The course looks at different ways of measuring costs versus benefits. Resources in health care work are always limited and it is important to exact the maximum amount of health care for the money. This is particularly challenging in poor countries,” says Professor Bjarne Robberstad from CIH who is responsible for the course.

CIH is part of the Department of Global Public Health and Primary Care at the University of Bergen (UiB).


Evaluating various alternatives

Economic evaluation of health care involves using different health measures to determine how the money used relates to the resulting health benefits.

With the assistance of decision-making analysis tools, students develop overviews of different treatment alternatives. They use specially-developed computer programmes to compare the costs of different measures cost and the resulting health benefits. The alternatives are entered into a decision-making model that is used to evaluate the different possibilities in relation to one another. According to Professor Robberstad, the model analysis is the most demanding part of the process. It is also the most important part because it may influence the choice of treatment.

“The most important aspect of the analyses is not obtaining a definitive answer, but to highlight all of the uncertainty involved in these types of decisions,” Professor Robberstad explains.


Practical benefits in Asia

The uncertainty analysis also provides important information concerning future research priorities.

“This is a practically-oriented course that is directly linked to what I am researching. I hope that what I am learning can contribute to us being better able, for example, to combat tuberculosis in Pakistan,” says PhD candidate Hamidah Hussain from the Department of Global Public Health and Primary Care at UiB.

Her research project concerns the early diagnosis of tuberculosis (TB). She compares the cost benefits of treatments offered in either the public or private sectors in Pakistan, one of the countries with the highest number of TB patients in the world. Her goal is to improve the treatment protocols at the Indus Hospital in the Karachi region of Pakistan.

“In this course I am learning precisely the analyses I need. I am using the computer programmes that I will use in my day-to-day work. Being able to build these analyses step-by-step is an incredibly helpful learning process,” she says.


Better health care in Africa

Master degree student Chukwuemeka S. Agbo from Nigeria says that this new course provides him with major practical benefits.

“This course is fundamentally important to my career within global health,” Agbo says.

He is a qualified doctor and is presently studying at VU University Amsterdam.

“In Africa we generally have many health problems, something I have seen close up in my work as a doctor. At the same time, health care resources are limited. This course helps me better compare different implementable health measures and is of great benefit to my everyday work,” says the Nigerian doctor. He adds enthusiastically:

“This is the only free course relating to the economic evaluation of health projects that I was able to find at a time when it was possible for me to take this kind of course. It really is a gold nugget in my academic toolbox.”

His long-term plan is to work with health organisations that collaborate between Nigeria and Thailand to establish better health care in both countries.


Evaluating TB-tests

Norwegian PhD candidate Ida Marie Hoel will research TB tests in her doctorate work. The World Health Organisation (WHO) recommends researching better diagnostic tests for TB, because, although there any many types of tests, none are close to being able to diagnose all cases of tuberculosis.

“The objective of my PhD is to introduce a new and cheaper method of testing in countries with high incidence of tuberculosis,” Hoel explains.

“The health economics course is therefore extremely important for my research. Regardless of whether our method will work or not, it is critical to determine how much more expensive or cheaper our method is compared with other methods.”

In terms of infectious diseases, TB is responsible for taking the largest number of lives in the world, after HIV. Even though the disease is now rare in Norway and is no longer included in the standard national vaccine programme, the number of instances of TB has increased in Norway during the past few years. The increase is largely attributed to immigration, and is thus affecting few ethnic Norwegian citizens.

“Health economics is important because it provides an overview of costs and benefits. Based on this, it is easier to make a choice about the test one might wish to use at any time,” Hoel says.


Understanding cost-benefit analysis

The health economics course is divided into a theoretical part and a practical part with group work. The goal is to develop and understand the fundamental principles, possibilities and limitations that are involved when conducting an economic analysis of different, potential health measures.

“The purpose of the course is that the students not only learn the theory but also learn to plan and implement a cost and benefit analysis in practice,” Professor Robberstad explains.

The course is part of the international teaching network tropEd, which is a worldwide collaboration within higher education in global health. The courses are carefully evaluated between the collaborating universities. If a tropEd course is completed at one location, it is approved as part of a master or PhD degree at another tropEd-affiliated university.

The collaboration provides CIH with excellent opportunities for recruiting new, young researchers to their courses. It helps the centre to further expand its international network.

“In future, we will offer the course every spring. The course has a duration of two weeks for master's students and three weeks for doctoral candidates,” says course supervisor Bjarne Robberstad.

This article is also published in the UiB Magazine 2015/2016. You can download a PDF of the full magazine or browse the magazine online.