Health Governance and Economics

Question :

This assessment will cover following questions:

  • Critically analyse the health economic and health economic methodologies and its role in evaluating public health policy formulation and decision making.
  • Examine the basic principle of governance and suggest ways that help to improve health and reduce inequalities by using good governance.
  • Analyse the difference and various functions of health service financing.


Answer :


The selected article is based on the exercise intervention and its effectiveness for reducing the cancer related fatigue in patients. It is necessary for care professionals to provide exercise activities and other relevant procedures which are helpful to improve health status of an individual suffering from different kind of cancer. However, it is observed that cancer patients usually feel weak and uncomfortable which negatively impact on their process of overcome with the health problems and reduce recovery speed. In addition to this, the programme of 18 weeks including exercise for patients suffering from colon and breast cancer in terms of improving the medical condition properly. It is analysed that such programmes are required to be organised in more effective as well as efficient manner to gain cost effectiveness by implementing the given intervention for well-being of patients. Moreover, physical activity is helpful to boost up their activeness of people which make hem feeling comfortable and follow their medication routine in order to become disease free (Cramer and et. al., 2016). It has been analysed that cancer is of different types such as carcinomas, sarcomas, leukaemias and lymphomas. Initially, the carcinomas begin to form in skim or tissue that overs surface of internal organs as solid tumours which include lung, colorectal, breast and prostate cancer. Secondly, the sarcomas start from connecting tissues and develop in muscles, nerves, joints, tendons, blood vessels, lymph vessels, cartilage, boner or fat. Thirdly, leukemia is known as cancer of blood where blood cells change and growth uncontrollably which consist acute or chronic lymphocytic leukaemia and acute or chronic myeloid leukaemia. Furthermore, the lymphomas can be consider as a cancer of lymphatic system which is network of glands and vessels. It has two types like Hodgkin lymphoma and non-Hodgkin lymphoma. The selected article has been analysed that intervention of physical exercise programmes is helpful to reduce the fatigue in patient of breast and colon cancer respectively.

On the other hand, it has been evaluated that the role of networks established by care professional teams is responsible or creating effective planning to improve patient outcomes. It is necessary for health organisations to connect with each other so that they can help one another in emergency situations to deal with people suffering from breast and colon cancer (Wu and et. al., 2017). Meanwhile, health care practitioners and social care professionals should perform collaboratively to provide appropriate care services for welfare of patients. However, the principles of clinical clinical governance can be described as a process of quality assurance which helps to understand that desired standards of care are maintained and improved which achieving better outcomes. It includes that medical professional should follow relevant pillars of clinical governance while implementing exercise programmes for cancer patients such as Information & IT, Risk management, audit, education & training, effectiveness of clinical care, staff management and patient & public involvement. Moreover, it has been analysed that evidence based practices should be applied in clinical practices to gain assurance of attaining appropriate patients outcomes (Chambers, Rogers and Boath, 2016). It is necessary or care professionals to adopt effective techniques which are already studied and proved by investigation that they are beneficial for cancer patients. Furthermore, it is very important to attempt a trail and study on the intervention of physical exercise to reduce the fatigue of people suffering from colon and breast cancer before implementing it in clinical procedures. It is favourable to avoid negative results and ensure accuracy of the process to improve condition of individuals.

Study validity

Did the study address a clear question?

Yes, this study address a clear question on cost effectiveness of exercise programme for colon cancer patient who are undergoing chemotherapy but not for the breast cancer patient. The survival rate of breast cancer patients are increasing and fatigue is the most common side effect in this cancer. The several analyses reported that exercise approach has focused on the effectiveness but it is also the cost-effectiveness. So, to make the intervention effective to the cancer patient the evaluation of health economic is dependent on the decision making. In order to analyse the cost-effectiveness, the randomised controlled trial was conducted to help the patient during the exercise intervention. They analyse the cost-effectiveness of 6 month of exercise intervention (Islam and et. al., 2017). After that, the physical activity during cancer treatment (PACT) analyse the 18 week of cost-effectiveness of intervention that are applied after the diagnosis of cancer. The PACT program performed according to the social perspective to measure the economic of the organisation. With help of PACT methodologies, it help the colon patient to prevent from the fatigue side effects. In their methods they use 1 hour of exercise twice per week for approx 18 weeks and the outcome of this is that it can prevent the effect of fatigue from the cancer patients.

Is the economic evaluation valid?

The economic evaluation in PACT study is the cheaper and cost savings as the health of the colon cancer is effectively increasing from the intervention of exercise. It increase the health of colon cancer patient on a much level who are suffering from fatigue. The frame work of the cost in less than the 1 year consist of evaluation of missing cost data with per cost evaluation. This can be implemented with health method that is Markov chain Monte Carlo method, who taking the access of all cost including the age and gender of any group. The economic evaluation is valid as it measures the loss of productivity and it is measured every 4 weeks including the patient history. The cost of PACT were evaluated with the micro- costing method. The decision making in providing the cost to physiotherapist were determined. The remaining cost were determined between the hospitals and research groups. The economic evaluation of cost from intervention of exercise increase the cost savings of up to € 4321. The cost-effectiveness from the exercise intervention is up to the 2%. With this cost-effectiveness the rate of consequences in exhibiting the role of initiative in decrease the effect of fatigue can be occur. The consequences of this is that 204 patients of breast cancer and 33 of colon patients are undergoing this treatment apart from chemotherapy. But for the breast cancer it is not much cost-effectiveness in providing the exercise intervention.

How were the costs and consequences assessed and compared?

The cost and consequence can be compared between the breast and colon cancer patient in order to provide them intervention of exercise. The cost were evaluate to prevent the cancer patients from the fatigue. There are cost were initiated to the professionals to provide the exercise to the patients twice a week. Their intervention includes the 1 hour of aerobic exercise and opposition exercise. But for the breast cancer the results of cost-effectiveness did not show. The comparative in cost-effectiveness is depends on the cost saving from they intervention and on the quality-adjusted life years. The ratio of cost savings shows the improvement in QALY of 0.03%. The incremental cost in exercise and physical fitness intervention is the not much higher . As the breast cancer patient does not attain the effectiveness of exercise intervention which cause the low in outcomes of decrease in their fatigue. This also compare because of the outpatient of 7 hospital of Netherlands from which the majority of general hospitals is 6 and the number of academic hospital is 1. The cost-effectiveness can be compared with in the consequences of 9 month of intervention period with the random study of PACT. The cost-effectiveness of breast cancer and colon cancer patient is differently occur. The cost increment for colon patients is high than the breast cancer patient but the consequences of the intervention is high in the colon patient than the breast cancer.

Study results

The selected study is all about the cost effectiveness analysis in an 18-week exercise programme for patients with breast and colon cancer undergoing adjuvant chemotherapy. It is a kind of randomised PACT study which has been carried out with the help of conducting trail of patients and understand its effects on them. However, the aim of this investigation is to evaluate about the intervention of physical exercise is effective in order to decrease the fatigue condition of people who were suffering from cancer of colon and breast (Van and et. al., 2016). The proper research has been conducted by having an aim to assess the cost effectiveness of the 18 week physical activity during cancer treatment (PACT) intervention for patients with breast and colon cancer. It has been identified that PACT trail in a group of people provided beneficial effects in regards to physical fitness as well as fatigue. In context of this study, the design considered is the randomised controlled multicentre PACT study regarding the cost effectiveness with a time horizon of 9 months. The patients selected for the given trail are from outpatients clinics from around 7 hospitals in Netherlands in which 6 are general hospitals and rest of 1 is an academic care organisation. The sample size of participants consist 204 patients who were suffered from breast cancer including 33 with colon cancer and they were undergoing adjuvant treatment of chemotherapy.On the other hand, the intervention selected for conducting investigation was supervised 1 hour aerobic and resistance exercise which was carried out for twice in a week or usual care. This study is about to conduct meta analysis of impact of physical exercise for reducing fatigue in cancer patients along with improving their health condition. It is required to evaluate and measure the overall outcomes related to quality adjusted life years, cost and incremental cost effectiveness ratio regarding organising the physical exercise programmes. The results of the study of selected article showed that intervention of physical exercise is cost effective in case of colon cancer (Van Zwanenberg and Harrison, 2018). It indicates beneficial effects along with incremental cost savings of around €4321 and QALY improvements of 0.03. However, it is also evaluated that this intervention is cheaper and most effective in case of colon cancer patients as it is favourable for improving their health condition. In contrary to this, this intervention is not cost effective for breast cancer and in this case the incremental costs were €2912, and the incremental effect was 0.01 QALY. At a Hutch threshold value of €20…000 per QALY, the probability that the intervention is cost-effective was 2%.

Application to practice

Does the study present information in a particular way to aid decision making ?

Yes, the study presents information in a very particular manner so as to assist in making peculiar and essential decisions. Though, the physical activities were not effective in patients with breast cancer. Thus, a prior and clear decision can be made through such results that the physical exercise has no positive result in controlling or lowering the condition of fatigue. The incremental cost effectiveness ratio (ICER) which was intended as the distinction in costs divided by the difference in QALYs among the involvement as well as manageable groups using a bootstrap analysis with few simulations. From such type of analysis, a cheap as well as cost efficient level was shaped, results were produced according to the intervention and analysed whether it is more or less pricey and more or less effectual when compared to the general medication and care. Moreover, cost effectiveness acceptability curves (CEACs) are presented to demonstrate the decision uncertainty, which further aid in making and comparing the made decision. The potency of this research is multi dimensional, casual and practical propose.

When the study has been compared to the explanatory trials, the decision making policies were more reflected by the daily test and clinical inputs. Since the patients of cancer are increasing day by day and large number of individuals are surviving from various cancers and fighting every day. In this case the need to adopt most affordable and economically cheap way has to be invented for improving the symptoms and conditions of the cancer patients. Therefore, such information guide in making decisions that what other cheap as well as cost effective methods can be adopted other than physical exercise to comfort such victims. Various decisions regarding the treatment of breast cancer can be taken and different therapies like tele therapy and radiation therapy and several surgeries and medication may be used to comfort the victim.

Are the results applicable to the scenario described above? How might they be applied?

The particular study is all about the cost effectiveness analysis in an 18-week exercise programme for patients with breast and colon cancer facing adjuvant chemotherapy. A certain type of random PACT study which particularly done to determine the effects either positive or negative on the patients suffering from breast and colon cancer. Moreover, the study majorly focus on examining the effects of physical exercise and to identify whether such practice aids in lowering the condition of fatigue particularly in the victims of colon as well as breast cancer. At the end of the study it has been concluded that the effects of physical exercise were only effective in the colon cancer and fatigue condition got improved to a great extent in the patients suffering from colon cancer.

The urban population in United Kingdom which have been observed to greatly affected by the colon and breast cancer can be eased by applying the cheap and cost effective techniques which is used in this study. It has been observed that breast and colon cancer incidence rates are very much high in such areas and some communities. Thereby, such results can be applied on the urban population of the UK on those who are suffering from the colon cancer. The public health practitioners who are working in cancer organisation or in non governmental organisation, such results can be utilised in promoting as well as managing the disease. Such measures of treating the fatigue condition in people anguishing from colon cancer can also be employed in enhancing the positive outcomes and improving the techniques in preventing and overseeing the cancer.

How do the findings fit with other similar studies?

The findings which were found in this study were regarding the fatigue situation of the folks who were tormenting from colon and breast cancer. The appropriate research has been under went by having an aspire to assess the cost effectiveness of the 18 week physical activity during cancer treatment (PACT) intervention for patients with the colon and breast cancer. It has been observed that the PACT path in a set of people furnished advantageous effects in respect to physical fitness as well as lowering of fatigue.

As per this study, the aim considered is the randomised guarded multi dimensional PACT examination on the subject of the cost effectiveness within a time period of 9 months. Other findings with similar study which have been found with respect to this research was randomised controlled trial (RCT) which was utilised while researching the cost effectiveness and efficiency of a 6 months home based exercise intervention in the victims of breast cancer undergoing same adjuvant therapies. Another study reflected that the patients who were diagnosed with early breast cancer were subjected to 12 week programme of exercise which was fully supervised under the skilled and professional health and social care providers. During this, realistic randomised controlled potential trial was designed for researching on 203 women, where the women were asked to get warm up in 5 to 10 minutes in class then 20 minutes exercise were followed by relaxation period . The outcomes were measured by functional assessment of cancer therapy (FACT). The following research was concluded that the group which was constantly supervised rendered psychological and functional benefits subsequent to 12 weeks intervention. Thus, the policy makers as well as clinicians should include more opportunities of exercise and physical activities in cancer cure services.

Also Read - Different Determinants of Health


From the above report it can be concluded that it is obligatory for care providers to offer exercise setups as well as actions and other significant measures which are accommodating in health condition of a person distressing from diverse sorts of cancer. This research concluded that the cost effectiveness of exercise programme for colon cancer patient who are receiving chemotherapy were successful but not suitable for the breast cancer victims. It has been evaluated that the economic evaluation in PACT study is less pricey as the health of the colon cancer is successfully mounting from the involvement of exercise. The study aids in making decisions regarding the treatment procedure of colon and breast cancer.

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