Context
The objective of this
systematic review was to determine the costs, benefits, and overall economic
value of communication campaigns that included mass media and distribution of
specified health-related products at reduced price or free of charge.
Evidence Acquisition
Economic evaluation studies
from a literature search from January 1980–December 2009 were screened and
abstracted following systematic economic review methods developed by The
Community Guide. Data were analyzed in 2011.
Evidence Synthesis
The economic evidence was
grouped and assessed by type of product distributed and health risk addressed.
A total of 15 evaluation studies were included in the economic review,
involving campaigns promoting the use of child car seats or booster seats,
pedometers, condoms, recreational safety helmets, and nicotine replacement
therapy (NRT).
Conclusion
Economic merits of the
intervention could not be determined for health communication campaigns
associated with use of recreational helmets, child car seats, and pedometers,
primarily because available economic information and analyses were incomplete.
There is some evidence that campaigns with free condom distribution to promote
safer sex practices were cost-effective among high-risk populations and the
cost per quit achieved in campaigns promoting tobacco cessation with NRT
products may translate to a cost per quality-adjusted life year (QALY) less
than $50,000. Many interventions were publicly funded trials or programs, and
the failure to properly evaluate their economic cost and benefit is a serious
gap in the science and practice of public health.
Table 2
Details of included studies
| Study and Year Location Population Design Type of economic analysis | Intervention components Length of intervention Volunteers and in-kind contributions | Effectiveness | Intervention cost and components | Economic benefits considered | Summary economic outcome |
|---|---|---|---|---|---|
| Child safety seat use | |||||
| St Louis 200819 Oakland County, MI Area Pop: 197,846 Low-income community pop: Not reported Hispanic community pop: 11,355 Pre-Post with Comparison Funded amount | TV, radio, print, small media, community mobilization, child seats, small group education 15 months Used volunteers | No difference for low- income community Hispanic community: Before - 9.7% After - 14.9% (Control: Before- 18.2%, After-14.8%) 358 free seats distributed | $53,209 grant to each of two communities No details about number of vouchers redeemed | None | None |
| Pedometer distribution | |||||
| Brown 20069 Eakin 200711 Rockhampton, Australia Pop: 60,000 (40,000 adults) Pre-Post with Comparison Funded amount and partial intervention cost | TV, radio, print, small media, pedometers, phone support, website, small group education, improved municipal signage and footpaths, formative research 2 years Volunteers and in-kind contributions | No significant effect | Grant plus in-kind contributions: $530,700 Includes paid advertising and event marketing: $17,400, with additional $43,500 in-kind | None | None |
| Condom distribution | |||||
| Alstead 19996 Seattle, WA Pop size not reported 15-17-year-olds in three communities within Seattle Pre-Post Partial intervention cost | Radio, small media, community mobilization, condoms, small group education, formative research 7 months Volunteers used | No significant difference in condom use at last intercourse between those exposed and unexposed to campaign | $276,617 for formative research, media and placement, professional advertising and vending services plus $15,000 for condoms | None | None |
| Kahn 200113 Intervention: Eugene, OR Control: Santa Barbara, CA Target gay men aged 18-27 years (approx 1,100 in area) Pre-Post with Comparison Modeled cost- effectiveness | (Print, small media, community mobilization, small group education, formative research, condoms) 8 months Modeled 1, 5, 20 years Volunteers used | 27% reduction in risk sex behavior (measured as reduction in unprotected anal sex) Assumed reduction in risk translates directly to same percent reduction in HIV incidence. Authors provide rationale for assumption based in literature. | $113,641 or $676 per person (For personnel, computers and supplies, publicity and communications, condoms, travel, workspace) | Health care averted based on lifetime medical care cost for treating HIV infections using estimates from literature | Societal net savings= intervention cost minus averted medical costs: 1 year: $265K 5 years: $875K 20 years: $1,714K |
| Kennedy 200014 Sacramento, CA About 6,000–10,000 sexually active adolescents Pre-Post with series of surveys Funded amount | Radio, small media, community mobilization, phone support, small peer-led group education, condoms 1 year | OR of condom use with main partner at last intercourse: 1.26 OR of condom carrying: 1.27 | Funding: $335,358 (~$42 per target person) No component details provided | None | None |
| Rebchook 200616 Multiple sites, U.S. Young gay men Cross-section of 26 community-based organizations (CBOs) Program budgets | Print, small media, community mobilization, small group education, formative research NA – data collected during 2002–2005 | NA | 26 CBOs provided data Annual operating budget: >$171K: 19%; $79,800-$171K: 19%; $22,800- $79,800: 5%; ≤$22,800: 23%; Don’t know: 23% Avg: $112,570; Median: $80,370; Range: $7,980– $394,349 | NA | NA |
| Recreational helmets distribution | |||||
| Bergman 19908 Seattle, WA Elementary school children and parents (N=56,179) Pre-Post with Comparison Product discount information | TV, radio, print, small media, community mobilization, helmets, phone support 3 years Volunteers used | At 16 months: Intervention (Seattle): – 5% to 16%; Control (Portland): 1% to 3%; Difference: 9% | Only intervention cost was $5K contribution to small media. Usual price of helmets $40–$60. Round 1: $19.95 helmets with coupons (5,155 of 109,450 coupons redeemed) Round 2: $25 helmet sales increasing from 1986-1.5K; 1987- 5K; 1988-22K; Partial 1989-30K | None | None |
| Levy 200715 Denver, CO Pop. size not reported Skiers and snowboarders in area Pre-Post with Comparison Product discount information | TV (newscast), print, small media, community mobilization, helmets, formative research 4 ski seasons starting 1998-1999 Volunteers used | Helmet acceptance among renters: 1998-99:13.8% 2001-2002: 33.5% For control stores, corresponding percentages were 1.38% and 4.48% Observations of helmet days/rental days: 98-99: 2,150/15,567 99-00:55,581/179,705 00-01: 44,351/132,219 01-02: 75,037/224,008 Observed helmet use on slopes by skiers: 98-99: 7.7% to 01-02: 20.3% | Usual helmet rental cost: $3.74 to $12.46 provided free to renters of package. Based on helmet days from effect size and lower estimate for rental cost, 4-year outlay was $662,425 with annual average of $165,606 | None | None |
| Rouzier 199517 Grand Junction, CO 8,600 elementary school children and parents Pre-Post Product discount information | Radio (news), print, small media, community mobilization, helmets, small group education 2 years Volunteers used | Observed helmet use over 3 years: 1992: 5.6% 1993: 12.5% 1994: 30% | Phase 1: Helmets purchased for 18.36-$26.01. 1,080 sold for $7.65; 1,080 for $22.95; and 240 for $26.01 Phase 2: 4,000 sold for $19.87 | None | None |
| Smith 199118 Oakland County, MI 3,100 middle and junior high students and parents from six schools Pre-Post Funded amount and partial intervention cost | TV, small media, community mobilization, phone support, small group education, formative research 5 months | Self-reported helmet ownership increased from 5% to 18.5%. From pre to post, parent-reported helmet use 50% of time increased ~2% to ~4% for low-intensity group and ~2% to ~11% for high- intensity group | Grant $358,355 fully financed intervention. 200 helmets given away in low-intensity group at cost of $14681.28 63 helmets given away in high- intensity group for cost of $4624.80 | None | None |
| Wood 198821 Victoria, Australia Statewide population Pre-Post Partial intervention cost | TV, radio, print, small media, reduced price, formative research 1 year Volunteers used | Metro Melbourne: Observed helmeted: Primary school students: 4.6% in 1983 to 38.6% in 1985 Secondary school students: 1.6% in 1983 to 14.0% in 1985 Adults: 26.1% in 1983 to 42% in 1985 20% reduction in bicycle-related motor vehicle crash head injury in Victoria in 1982-1983 combined, compared to 1984 | Partial cost provided as cost of TV/radio campaign was $294,286; total cost of rebates for helmets of $745,200 (calculated by reviewers) | None | None |
| Nicotine replacement therapy (NRT) distribution | |||||
| Bauer 20067 Western NY All callers to quitline Pre-Post with Comparison Cost per additional quitline caller | Print, small media, community mobilization, phone support, NRT, supplies 3-4 weeks 3 Treated Arms: Arm 1: Newspaper and magazine ad with NRT Arm 2: Newspaper ad Arm 3: Newspaper ad with cigarette look-alike | Arm 1: Incremental calls – 4724 Quit (7-day abstinence): 22% for those redeeming NRT versus 12% pre-NRT, implying OR=1.77 Arm 2: Incremental calls – 14 Arm 3: Not reported Treated quits: 20% Controls: 24% | Arm1: $58,487 (For newspaper and magazine ad and NRT) Arm 2: $3,810 for newspaper ad Arm 3: Not reported (For newspaper ad and plastic cigarette at $1.71 each) | None | Cost per incremental call Arm 1: $12.54. Arm 2: $272.46 Arm 3: $93.48 |
| Cummings 2006a10 (linked to Miller 200522 and Cummings 2006b23) 4 regions of New York Region I: Buffalo area, n=1,099 Region II: 8 counties, n=1,334 Region III: 15 counties, n=2,323 Region IV: NYC, n=35,334 All callers to quitline Pre-Post with Treated Comparison Cost per additional quit | Radio, print, small media, NRT, phone support 4 regions with varying durations of free NRT and type of media Region I: 2 weeks with earned media Region II: 2 months with earned media and paid radio Region III: 4 weeks with earned media and print ads Region IV: 6 weeks with earned media | Daily call volume by region Region: Before/After I: 312/63=5.0 II: 393/79=4.97 III: 931/60=15.5 IV: 7,213/552=13.1 Region: Percent quits (risk ratio) Pre-NRT: 12% (1.0) I: 27% (2.9) II: 21% (2.0) III: 24% (2.4) IV: 33% (3.8) | Intervention cost (per enrollee) by region: I: $52,856 ($48) II: $43,823 ($33) III: $110,382 ($48) IV: $3.08 Mil ($87) | None | Cost per quit due to NRT by region: I: $312(n=169) II: $349(n=125) III: $396(n=279) IV: $396(n=7770) |
| Fellows 200712 State of Oregon Pop. size not reported All callers to quitline Pre-Post Cost per LYS | TV, radio, NRT, phone support, counseling 3 months | Calls to quitline Jan- June (monthly avg): Pre-Patch: 3,214 (136) Patch Period: 6,823 (1,137); Difference: 3,609 (602) Quits defined as 30- day abstinence at 6 months: Pre-Patch: 8.2% Patch:15.7% | Note: 2 months of paid ads assumed for post- patch period for cost-effectiveness analysis. Pre vs patch period Total cost: $224,5897 vs $256,5552 Media cost: $1,579,056 vs $483,789 NRT+counseling cost: $666,841 vs $2,081,763 | Quits converted to LYS based on age- specific estimates from literature | Pre vs. patch period Callers: 6,428 vs 13646 Quits (%): 527 (8.2) vs 2,142 (15.7) LYS: 1,246 vs 4,502 Cost/quit: $4,261 vs $1,197 Incremental cost/quit: NA vs $198 Incremental cost/LYS: NA vs $98 (Bounds of $25 to $402 per LYS based on sensitivity analysis on quit rate, intervention cost, and discount rate) |
| Tinkelman 200720 State of Ohio All callers to quitline Pre-Post with Comparison Partial intervention cost | NRT, phone support, formative research Multimillion $ media campaign but no details about channels. NRT became available in July 2005; 4-week supply plus another 4 weeks if continuing in program. NRT promoted through media Sept 2005–April 2006 (7 months). | Call volume per day: increase from 78 per day pre-NRT to 188 post-NRT Quit (7-day abstinence) 10.3% pre NRT and 14.9% post NRT, measured at 6- month follow-up. Post NRT quit rate 11.2% for Counseling Only and 20.2% for Counseling + NRT. | Pre-NRT (Jul 2004-Apri 2005) media costs $4,620,000; Post-NRT (Sept 2005–Apr 2006) $3,180,000. No cost of NRTs provided. Reviewers assumed difference went to finance free NRT. | None | None |
Full article at: http://goo.gl/KEZeVX
By:
Community Guide
Branch, Division of Epidemiology, Analysis, and Library Services (Jacob,
Chattopadhyay, Elder, Robinson, Tansil, Soler, Labre, Mercer), CDC, Atlanta,
Georgia.
Address correspondence and reprint requests to: Verughese
Jacob, Community Guide Branch, Centers for Disease Control and Prevention, 1600
Clifton Road, Mailstop E69, Atlanta, GA 30333. vog.cdc@0rih Phone: 404-498-6884 FAX: 404-498-0989
More at: https://twitter.com/hiv_insight
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