Cost-Effectiveness of Screening for and Early Diagnosis of Breast and Gynecological Cancers in Low-Income Countries

Abstract Background: Tuberculosis (TB) is a global public health problem, with the highest burden occurring in low-income countries, wherein the use of more sensitive diagnostics, such as Xpert MTB/RIF (GeneXpert), is still limited by costs. Testing of pooled samples from various individuals has been thought and thus investigated as a cost saving strategy to diagnose some diseases including TB. Then in cases where a pool is positive, retesting of the individual samples in that pool is done to identify the positive sample. We assessed the utility of a pooled testing strategy to optimize the affordability of GeneXpert for the diagnosis of TB Mwanza Tanzania. Methods: Remainder of samples from presumptive TB patients submitted for routine TB diagnosis were used for pooled samples (5 per pool) testing. The agreement of the results between individual sample testing against pooled samples testing and cost-effectiveness were assessed.Results: A total of 250 individual routinely submitted samples for TB diagnosis were tested using the established protocols. The median age of study participants was 35 [IQR 27 – 40] years and 143 (57.2%) were males. Of the 250 samples, 28 (11.2%) were detected to have MTB whereas 222 (88.8%) samples, were negative. Of the 50 sputum pools made, MTB were detected in 17 (34.0%) pools. Following retesting of these 17 positive pools, all 28 (100%) individual MTB samples were detected with the overall agreement being 100% (With the sensitivity of 100% and specificity of 100%). The number of individual MTB positive ranged from 1 to 3 per pool. Using pooling of sputum samples, the technique saved 115 (46.0%) of the cartridges in running 250 samples. This is equivalent to saving US$ 1147.7. Conclusion: The pooled sputum testing strategy reduced cartridge costs by 46.0%. The use of the pooled testing strategy reduces costs and has the potential to increase the affordability of GeneXpert testing in countries with limited resources. Pooled sputum for Xpert MTB/RIF can be used as an affordable diagnostic and/or screening tool in resource limited settings, such as Tanzania.

Download Full-text

Economic evaluation of hepatitis B vaccination in low-income countries: using cost-effectiveness affordability curves

Bulletin of the World Health Organization ◽

10.2471/blt.06.038893 ◽

2007 ◽

Vol 85 (11) ◽

pp. 833-842 ◽

Cited By ~ 30

Author(s):

Sun-Young Kim ◽

Joshua A Salomon ◽

Sue J Goldie

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Hepatitis B ◽

Low Income ◽

Low Income Countries ◽

Hepatitis B Vaccination

Download Full-text

Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries

The Journal of Infectious Diseases ◽

10.1093/infdis/jiv041 ◽

2015 ◽

Vol 212 (4) ◽

pp. 513-515 ◽

Cited By ~ 4

Author(s):

Benjamin P. Linas

Keyword(s):

Cost Effectiveness ◽

Low Income ◽

Low Income Countries ◽

Self Testing ◽

Potential Impact

Download Full-text

The Economics of HIV/AIDS in Low-Income Countries: The Case for Prevention

The Journal of Economic Perspectives ◽

10.1257/jep.20.3.121 ◽

2006 ◽

Vol 20 (3) ◽

pp. 121-142 ◽

Cited By ~ 38

Author(s):

David Canning

Keyword(s):

Cost Effectiveness ◽

Low Income ◽

Low Income Countries ◽

Middle Income ◽

Middle Income Countries ◽

Treatment And Prevention ◽

Prevention And Treatment ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome ◽

Hiv Aids

There are two approaches to reducing the burden of sickness and death associated with the human immunodeficiency virus (HIV), which leads to acquired immunodeficiency syndrome (AIDS): treatment and prevention. Despite large international aid flows for HIV/AIDS, the needs for prevention and treatment in low- and middle-income countries outstrip the resources available. Thus, it becomes necessary to set priorities. With limited resources, should the focus of efforts to combat HIV/AIDS be on prevention or treatment? I discuss the range of prevention and treatment alternatives and examine their cost effectiveness. I consider various arguments that have been raised against the use of cost-effectiveness analysis in setting public policy priorities for the response to HIV/AIDS in developing countries. I conclude that promoting AIDS treatment using antiretrovirals in resource-constrained countries comes at a huge cost in terms of avoidable deaths that could be prevented through interventions that would substantially lower the scale of the epidemic.

Download Full-text

Is physiotherapy an underused approach to prevent surgery in selective musculoskeletal disorders?

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v20i2.51557 ◽

2021 ◽

Vol 20 (2) ◽

pp. 409-413

Author(s):

Junaid Amin ◽

Sameer Gohir ◽

Umer Qaiser ◽

Ammar A Siddiqui ◽

Freah Alshammary ◽

...

Keyword(s):

Cost Effectiveness ◽

Musculoskeletal Disorders ◽

Low Income ◽

Medical Science ◽

Low Income Countries ◽

Long Term Outcomes ◽

Physiotherapy Intervention ◽

Musculoskeletal Problems ◽

The Cost

Objectives: The purpose of the literature review was to appraise the evidence that an early physiotherapy intervention helps to prevent the surgery in selective musculoskeletal disorders. A search of Google Scholar, Web of Science, Scopus, and PubMed was carried out utilizing the terms (“physiotherapy”, “surgery” OR “exercise, surgery” OR “rehabilitation”, “surgery”). Methods: The article titles and abstracts were screened for eligibility and included in the review. The recent literature evidently emphasized that physiotherapy has opted in selective musculoskeletal problems to avoid and delay surgeries. Results: Regardless of recommended conservative treatment option and effectiveness of physiotherapy, a massive gap can be observed between its evidence and practice. Conversely, overuse of diagnostic imaging, surgeries, and medications is present in clinical practice. In most of the clinical problems the long-term outcomes were reported the same with surgical and physiotherapy intervention. Likewise, patients can also get the advantage of better clinical outcome and cost-effectiveness with physiotherapy as compared to surgical intervention. Conclusion: The cost-effectiveness is an important factor in low-income countries where economic aspects of health care are highly considered. These advantages of physiotherapy should be considered by the clinicians, policymakers, patients, and included in the clinical guidelines. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.409-413

Download Full-text

The merits of sustaining pneumococcal vaccination after transitioning from Gavi support – a modelling and cost-effectiveness study for Kenya

10.1101/369603 ◽

2018 ◽

Cited By ~ 1

Author(s):

John Ojal ◽

Ulla Griffiths ◽

Laura L. Hammitt ◽

Ifedayo Adetifa ◽

Donald Akech ◽

...

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Low Income ◽

Disease Incidence ◽

Pneumococcal Vaccination ◽

Cost Effective ◽

Low Income Countries ◽

Pneumococcal Carriage ◽

Disability Adjusted Life ◽

Disability Adjusted Life Year

AbstractIntroductionMany low income countries soon will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full costs as they transition from Gavi support. Using Kenya as a case study we assessed the incremental cost-effectiveness of continuing PCV use.MethodsWe fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya, and predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya’s transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted-life-year (DALY) averted and associated prediction intervals (PI).ResultsWe predicted that overall IPD incidence will increase by 93% (PI: 72% - 114%) from 8.5 in 2022 to 16.2 per 100,000 per year in 2032, if PCV use is discontinued. Continuing vaccination would prevent 15,355 (PI: 10,196–21,125) deaths and 112,050 (PI: 79,620– 130,981) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15.6 million annually compared to discontinuing vaccination. The incremental cost per DALY averted of continuing PCV was predicted at $142 (PI: 85 - 252) in 2032.ConclusionContinuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective. These arguments support an expansion of the vaccine budget, however, affordability may be a concern.FundingFunded by the Wellcome Trust.

Download Full-text