Trial of Program Budgeting and Marginal Analysis (PBMA) to assist cancer control planning in Australia

In mid-1999, the Cancer Strategy Group (CSG) of the National Health Priorities Committee, resolved to trial the use of the Program Budgeting and Marginal Analysis (PBMA) approach. The trial was to address whether PBMA is an appropriate technique to include in CSG’s strategic planning process, as well as assist with what specific options might be included in the next National Cancer Strategy. Advocates of the PBMA approach believe it offers a practical way of applying the economic principles behind the achievement of “allocative” and “technical” efficiency. It is argued that PBMA allows the concept of “benefit” to be clearly related to program and/or organisational objectives and for best available evidence to be utilised in an open and systematic planning process. It is clear from the literature that substantially different evaluation approaches are possible within the overarching framework of PBMA. The key characteristics of the PBMA approach adopted in this trial were: a focus on the marginal analysis component of PBMA, combined with a clear rationale for selection of the options for change; an evidence-based approach with a small research team bringing together the best available information; the choice of the Disability Adjusted Life Year (DALY) as the measure of health gain; the recognition that “benefit” is broader than just health gain; adoption of a two-stage approach to the assessment of benefit involving both “technical” aspects (i.e. cost per DALY recovered; level of evidence) and “judgement” aspects (i.e. equity; size of the problem; acceptability to stakeholders; and feasibility of implementation); and an economic protocol specifically developed for a priority setting context.

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