Assessing the costs of organised health programs: The case of the National Cervical Screening Program

Economic evaluations of health care programs are relatively common. However, the costs reported often use budgetary information alone, rather than undertake the potentially more complex task of using a variety of routinely collected data for which adjustments and assumptions will need to be made. Relative to the effort required for an individual-level costing exercise, investigating the costs of a health care program targeted at a population or group is likely to be a more complex and difficult undertaking. This paper describes the process of undertaking a program-level cost analysis, using principles developed to ensure the quality of such evaluations. Documenting the costs of the National Cervical Screening Program is used to illustrate the approach and the difficulties encountered, assumptions made and solutions employed are discussed. Despite the limitations to estimating the costs of health programs identified in this paper, evaluators can take full advantage of the data available by using a systematic description of the program as a basis for costing, testing the assumptions and adjustments needed using the expertise available within a specifically appointed advisory or working group and using sensitivity analysis to provide a greater level of confidence in the results.