Abstract

University of California, Merced

Return on Investment for the Merced California Accountable Communities for Health Initiative

A dissertation submitted in satisfaction of the requirements

for the degree of Doctor of Philosophy in Public Health

by Ravi Singh

2020

The use of return on investment (ROI) analysis in public health is steadily increasing in recent years. Local health departments (LHDs) have started using ROIs more frequently to secure funding for their program and initiatives, as ROIs are viewed to be more attractive to potential funders compared to other evaluations. The Merced California Accountable Communities for Health Initiative (MCACHI) focused on reducing diabetes, heart disease, and associated depression in Merced County by implementing the National Diabetes Prevention Program (NDPP). The purpose of this three-paper dissertation was to estimate the ROI for the MCACHI, while providing a framework for researchers and LHDs for using ROIs for chronic disease prevention programs working closely with a community advisory group (CAG) .The reason the MCACHI was interested in estimating the ROI was to use it as a way of presenting to potential funders in the region that the program is a good investment, hoping the project can become sustainable. The second chapter aims to place a value by the general population for public health programs done in their communities, using a discrete choice experiment (DCE). The third chapter aims to cost out the entire MCACHI, estimating costs for the actual program as well as costing out the program if more people completed it and if it was implemented more efficiently. The fourth chapter of this dissertation aimed to calculate the ROI for the MCACHI, using information from the second and third chapter, while also providing a framework for using two methodologies for placing monetary values on health outcomes. The first method used information from the DCE in chapter two to estimate the willingness to pay (WTP) for the diabetes prevention program, and the second method used quality adjusted life years (QALYs) to place a monetary value on the health outcomes. This study found that the ROI is sensitive to many parameters and has the potential to show the program was a good investment over a longer time horizon.

Keywords: LHD, QALYs, ROI, WTP