Preface to Special Issue on Cost-Effectiveness Analysis
SCOTT C. RATZAN
This special issue of the Journal of Health Communication:International
Perspectives, coedited by Jane Bertrand of Johns Hopkins University
and Paul Hutchinson of Tulane University, examines the current challenges
addressing cost-effectiveness, namely, costing communication programs,
as well as measures their effectiveness.
Those of us engaged in applied research in the field of
health communication are
aware of the challenges posed by agencies and donors requesting demonstrations
from investments in communication. Of course, many reading this issue
already
may be convinced of the value of communication as an intervention;the
trend
toward evidence-based approaches and results includes demonstration
of effectiveness including economic factors.
Questions on return investment (e.g. health outcomes,
cost-effectiveness, etc. ) have been tantamount to the field with related
research addressing these issues. In 2000, USAID had reviewed 283 articles
in both peer-reviewed and other literature related to health communication
outcomes, 93 of which met the criteria for an evidence-based study (for
information see http://www.comminit.com/strategicthinking/usaidreport/sld-1932.html).
Some of the same questions identified in this analysis are addressed
in this special issue. How much do we really know? Are we using the
right approaches? Should there be quality standards for methodology
and reporting? Are we examining/measuring the right indicators for impact
and success?
This issue provides the latest evidence and expert analysis
on cost-effectiveness. Dr. Hutchinson suggests that an alternate title
for this issue is ‘‘Determining the Bang for the Buck.’’
Cost-effectiveness helps us decide which programs give us the best outcome
for the cost by answering questions like, ‘‘How we can make
sure that we are getting the most behavior change for our program dollar?’’
and ‘‘Can we alter the mix of our different communication
subinterventions to achieve greater gains?’’ or ‘‘Can
we demonstrate that health communication interventions are a bargain
relative to other alternatives?’’ This set of research further
challenges us to think of the standardized approaches in public health
and economics (e.g., the use of disability adjusted life years [DALYs]).
While the applied communication examples in this issue are from developing
countries, a review of the existing literature on the cost- effectiveness
of communication programs to produce health outcomes identifies 45 studies
both in developed and developing countries. Methodological applications
with sound principles and applications as demonstrated herewith should
promote the appropriate use of cost-effectiveness analysis in relation
to communication in behavior and social change programs.
Ideally, these articles and the body of literature can
be coupled with ethical ideals, creativity, and financial support to
achieve the health outcomes that include communication as an intervention.
As readers and researchers, we should continue to publish our results
with ‘‘standardized ’’methodologies and measures.
Yet, it is incumbent upon us to advance our field and quality contribution
by continually challenging ways to measure and add value; share experiences
across countries, cultures, and environments; explore new design approaches
and perhaps theoretical constructs; demonstrate the impact of ‘‘noise’’
(e.g., debate and dialogue) vs. planned and crafted messages; harness
new technologies and approaches; and advance ethical decision making.
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Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal of
Health Communication: International Perspectives. He also is Vice
President, Government Affairs, Europe for Johnson & Johnson with
academic appointments at George Washington University School of Public
Health, Tufts University School of Medicine, Yale University School
of Medicine, The College of Europe, and University of Cambridge.
