Identifying and controlling for program-level differences in comparative cost analysis: lessons from the economic evaluation of the National Breast and Cervical Cancer Early Detection Program

Performing economic evaluations of established health care programs is essential to identify and control for underlying program-level variations and to make valid comparisons. At a time when the need for such evaluations is growing, health care professionals have limited information on the methodological challenges of performing these evaluations. In this study, we used the National Breast and Cervical Cancer Early Detection Program to illustrate these potential underlying variations. We performed site visits to four grantees and collected activity-based cost data from nine additional representative programs. We identified five specific types of cost factors that should be considered when evaluating and comparing health care programs: clinical services, service mix, in-kind contributions, indirect costs, and year-to-year expenditures of specific activities. A key lesson is that case studies and pilot testing should be performed before initiating cost analysis to identify underlying variation and to test appropriate methods to adequately control for these differences.     

Using social media-based drama therapy and family counselling to treat symptoms of postpartum depression among women

This study examines the impact of social media-based drama therapy and family counselling in reducing symptoms of postpartum depression (PPD) in women aged 18–34. The researchers used a quasi-experimental design and randomly assigned the participants (n = 303) to the control, drama therapy, and family counselling groups. The key findings of the study are as follows. First, at baseline, women not only showed more symptoms of PPD than their male counterparts, but men also reached the PPD threshold of 12/13. Second, the difference between women and men regarding their PPD scores achieved statistical significance (p = 0.004). However, during the post-intervention assessment, men who received drama therapy intervention reported a significant drop in their PPD below the threshold of 12/13. Only women whose spouses received family counselling on spousal support reported a significant drop in their PPD. However, those whose partners did not receive family counselling on spousal support still reported PPD scores within the threshold. In both instances, women in the control group still had high PPD scores. Finally, during the 6-month follow-up assessment, even men in the control group did not have significant symptoms of PPD as their scores dropped below the threshold. On the contrary, women in the control group still had high PPD, indicating that PPD lasted more in women than in men. Also, women whose husbands received family counselling on spousal support reported PPD scores below the threshold. However, women whose husbands did not receive spousal counselling still had PPD scores at the threshold, even though their scores marginally dropped.