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Cost-Effectiveness Analysis
- alternative of CBA
- in programs where it is difficult to assign monetary value cost-effective analysis (CEA) can help the decision
makers in making judicious allocation of resources
- has been used extensively for evaluations of health, educational, and environmental programs
- basic purpose: to identify programs that can attain specific objectives at the lowest cost
- involves identification of the alternatives, an estimation of their costs, and an assessment of their
effectiveness
- Cost Estimation
o takes into account both the direct and indirect costs of the intervention
o Direct Costs
costs of inputs, like personnel, equipment, materials, utilities
o Indirect Costs
externalities or ‘spillover’ effects associated with the intervention and should be included
in the cost calculation
o Volunteers and Donated Resources
omitted in normal cost accounting
use opportunity cost = market prices reflect opportunity cost
If not available, use proxies
- Cost-effectiveness is measured using
o Cost-effectiveness Ratio
ratio of the cost of a program to the effects produced
For independent programs, ratio is calculated for each alternative and ranked in
ascending order = project with the lowest cost-effectiveness ratio is the most cost efficient
and gets the highest priority
o Incremental Cost-effectiveness Ratio (ICER)
ratio of the difference in costs to the difference in effects between two alternative
programs
For mutually exclusive programs, programs are ranked based on their effectiveness and
principle of strong dominance is applied, wherein program that is less expensive and more
effective is considered for implementation (based on the availability of funds or the
society’s willingness to pay)
- CEA a very useful tool for program appraisal, planning, and implementation
- Problems of CEA
o Similar to CBA
o There should be a discount rate because costs and effects can change through the years
o Choice of discount rate that may affect the outcome of the analysis
o Qualitative differences of the program that will be added as costs to deficient program
o Uncertainty about the future
- Cost-effectiveness acceptability curve (CEAC) is one such measure that indicates the probability that a
program is cost-effective in comparison to the alternative for a given value of the maximum socially
acceptable cost-effectiveness ratio
o Important to carry out sensitivity analysis
References
Shah, A. (2020). Policy, Program and Project Evaluatiom. Cham Switzerland: Springer Nature Switzerland
AG.