A resource-limited setting shows high rates of congenital syphilis despite antenatal screening programs. Lab records show stock-outs and delayed results. Which integrated approach is most cost-effective?

Implementation of point-of-care testing with same-day treatment

Enhanced partner notification only

Universal prophylactic treatment

Increased lab capacity with result tracking system

Which of the following does not include Specific protection under primary prevention?

Tab Rifampicin to those in contact with meningitis

Wheat flour fortified with added iron

Why is a regimen of four drugs recommended for a TB patient on the first visit?

To prevent emergence of drug-resistant strains

To reduce bacterial load effectively

Which of the following statements is TRUE regarding Disability-Adjusted Life Year (DALY)?

DALY includes both Years of Life Lost (YLL) and Years Lived with Disability (YLD).

Years lost due to disability (YLD) are not considered in DALY.

DALY only measures mortality and does not include morbidity.

DALY does not account for both YLD and YLL.

A 60-year-old male with a history of diabetes and hypertension is found unconscious. On examination, his pulse rate is 120/min and BP is 160/100 mm Hg. What is the next step in management?

Administer intravenous mannitol

Immediately reduce BP with antihypertensives

Cost-effective Care for FMGE: High-Yield Internal Medicine Lessons

Defining Cost-Effectiveness - Smart Spending Saves

Cost-Effectiveness Analysis (CEA): Compares intervention costs & health outcomes (QALYs, life-years).
Goal: Maximize health per Rupee spent; not just cheapest.
Indian Context: Crucial for India: resource limits, high OOP spending.
Key Metrics:
- ICER (Incremental Cost-Effectiveness Ratio): $ICER = \frac{(Cost_{new} - Cost_{std})}{(Effect_{new} - Effect_{std})}$. Extra cost per unit health gain.
- QALY (Quality-Adjusted Life Year): 1 QALY = 1 year perfect health.
- DALY (Disability-Adjusted Life Year): Years lost (death/disability).
WHO Thresholds (vs. GDP/capita):
- Highly cost-effective: ICER < 1x GDP
- Cost-effective: ICER 1x - 3x GDP
- Not cost-effective: ICER > 3x GDP

⭐ CEA guides resource allocation for max population health, vital in LMICs like India.

Economic Evaluation Tools - Crunching Care Costs

Tool	Cost Unit	Outcome Unit	Key Metric / Formula	Decision Rule (Example)
CMA (Cost-Minimization)	Monetary (₹)	Assumed Identical	Lowest Cost	Choose cheapest if outcomes same
CEA (Cost-Effectiveness)	Monetary (₹)	Natural (e.g., LYG, cases cured)	$ICER = \frac{\Delta Cost}{\Delta Effect}$	ICER < WTP threshold
CUA (Cost-Utility)	Monetary (₹)	QALYs, DALYs	Cost per QALY/DALY	Cost/QALY < WTP (e.g., 1-3x GDP/capita)
CBA (Cost-Benefit)	Monetary (₹)	Monetary (₹)	Net Benefit ($B-C$); $B/C Ratio$	$B-C > \textbf{0}$; $B/C > \textbf{1}$

Prudent Prescribing & Testing - Lean Medicine Moves

Prescribing Principles for Value:
- Generic substitution: Bioequivalent, offers significant ↓cost.
- Rational Drug Use (RDU): Adhere to Standard Treatment Guidelines (STGs), National List of Essential Medicines (NLEM).
- Combat polypharmacy: Conduct regular medication reviews, especially in elderly.
- Antibiotic stewardship: Crucial for ↓resistance, ↓overall healthcare expenditure.
Lean Diagnostic Strategies:
- "Choosing Wisely" India: Critically evaluate necessity of each test/procedure.
- Stepwise, targeted investigations: Avoid broad "shotgun" approaches.
- Utilize validated clinical decision rules (CDRs) for appropriate testing.
- Discuss test implications, benefits, risks, and costs with patients.

⭐ The Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) aims to provide quality generic medicines at affordable prices through Kendra outlets.

System-Level Strategies - Bigger Picture Benefits

National Health Policy (NHP): Aims for universal health coverage; ↑ public health expenditure to 2.5% of GDP by 2025; focus on preventive & promotive health.
Ayushman Bharat (PM-JAY): World's largest health assurance scheme; cashless access for secondary/tertiary care hospitalisation to over 12 crore vulnerable families.
Telemedicine & Digital Health (e.g., eSanjeevani): Enhances healthcare access, especially in remote areas; reduces travel costs & time.
Electronic Health Records (EHRs): Improves care coordination, reduces redundant testing, supports clinical decision-making.
Preventive & Promotive Healthcare: Emphasis on screening programs (NCDs, cancers), immunisation, health & wellness centers.
Generic Drug Promotion: (e.g., Pradhan Mantri Bhartiya Janaushadhi Pariyojana - PMBJP) for affordable quality medicines.
Centralized Procurement: Bulk purchasing of drugs, vaccines, and medical supplies to reduce costs.

⭐ Ayushman Bharat PM-JAY provides a health cover of ₹5 lakhs per family per year for secondary and tertiary care hospitalization across public and empanelled private hospitals in India.

High‑Yield Points - ⚡ Biggest Takeaways

Generic drug substitution is paramount for affordable patient care.

Evidence-Based Medicine (EBM) minimizes unnecessary tests and treatments.

Adopt a stepwise approach to diagnosis: history, examination, then targeted investigations.

Preventive strategies and health education are crucial for long-term cost reduction.

Rational antibiotic stewardship combats resistance and controls expenditure.

Appropriate referrals to specialists prevent needless costs and delays.

Avoiding low-value care (e.g., routine screening without indication) is essential.

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