Estimated Effectiveness and Cost-effectiveness of a Fortified Edible Oils Program in Ethiopia

Abstract Objectives In Ethiopia, standards for fortifying edible oil with vitamin A (VA) exist; they are not yet mandatory. This study assessed inadequate VA intake among children 6–35 months of age and women of reproductive age (WRA), modeled the potential impacts of VA-fortified edible oil on dietary VA adequacy and number of young lives saved, and estimated the cost-effectiveness of this program. Methods Using an adapted 1-day version of the National Cancer Institute method, we analyzed national dietary intake data from the Ethiopian National Food Consumption Survey to estimate usual VA intake and calculate prevalence of inadequate intake (proportion below the Estimated Average Requirement). The Lives Saved Tool (LiST) was used to predict the number of lives saved among children. Program costs were estimated using an activity-based approach and applied to calculate cost-effectiveness of the oil fortification program. Results Nationally, the prevalence of inadequate VA intake was high (∼80% children, ∼82% among women), with substantial spatial variation (children: 92% Amhara to 55% Gambella; WRA: 94% Amhara to 50% SNNP). Simulation results suggest that an edible oil fortification program (2000µg retinol/100g oil) would reduce, but not eliminate, inadequate VA intake among both groups. Nationally, a well-managed oil fortification program would reduce the prevalence of inadequate VA intake among children and WRA by ∼18 and ∼15 percentage points (pp), respectively; for children ∼38 pp in Addis Ababa but by only ∼8 pp in SNNP. Over 10 years, a well-managed program could save between ∼3700–5100 lives, just among non-breastfed children. A program to fortify imported oils (∼98% of all oils consumed in Ethiopia) with VA, including start-up investments and recurring M&E and border inspection activities, would cost ∼US$3.6m over 10 years. The cost-effectiveness of this program over a 10-year period would range from US$706-US$973 per life saved among non-breastfed children. Conclusions Results suggest that fortifying imported edible oils in Ethiopia is a cost-effective way to save young lives. However, this program alone will not be sufficient to eliminate all VA deficiency. Many options for complementary programs exist; program- and region-specific cost-effectiveness measures can help guide policy discussions. Funding Sources Bill & Melinda Gates Foundation.

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Selecting Micronutrient Intervention Programs to Save Lives: Evidence From Cameroon

Current Developments in Nutrition ◽

10.1093/cdn/nzab045_075 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 693-693

Author(s):

Stephen Vosti ◽

Katherine Adams ◽

Aleksandr Michuda ◽

Hanqi Luo ◽

Demewoz Woldegebreal ◽

...

Keyword(s):

Vitamin A ◽

Wheat Flour ◽

Edible Oils ◽

Cost Effective ◽

Reproductive Age ◽

Economic Optimization ◽

Adequate Intake ◽

Life Saving ◽

Program Costs ◽

Gates Foundation

Abstract Objectives We use the Micronutrient Intervention Modeling (MINIMOD) tool to identify and compare economically optimal sets of micronutrient (MN) programs that focus on two objectives: increasing the number of individuals achieving adequate intake of specific life-saving MNs, and saving children's lives using sets of MNs. Methods We used 24-hour dietary intake data from Cameroon to estimate usual intake of zinc and vitamin A for children 1–5 y (n = 872) and of folate for women of reproductive age (WRA) (n = 902), as well as the prevalence of inadequate intake (below the Estimated Average Requirement) for each. We simulated the effects on inadequate MN intake of single or combined fortification of wheat flour, oil, and/or bouillon cubes, as well as two delivery platforms for vitamin A supplementation (VAS). The Lives Saved Tool (LiST) was used to estimate the number of lives saved by each program, and by all combinations of them. We estimated program costs for each scenario, nationally and subnationally, over a 10-year planning time horizon. The economic optimization model was run twice to identify the most cost-effective combination of programs based on two objectives achieving adequate intake for each MN, and increasing lives saved by all MNs. Results When the policy focus is on adequate intake of specific life-saving MNs, the following national and subnational programs are most cost-effective: wheat flour fortified with zinc (95 ppm, at target level), edible oils (9 mg/kg, 75% of target) and bouillon cubes (80 ppm) both fortified with vitamin A, and VAS provided to children in the northern part of Cameroon via Child Health Days. For meeting the folate needs of WRA, wheat flour fortified with folic acid (5 mg/kg, 33% of standard) is the most cost-effective option. When the primary focus is saving lives, a very similar set of economically optimal programs emerges, which saves over 26,000 lives over 10 years. Conclusions Policymakers in Cameroon who promote mortality-reducing MN programs using adequate intake and economic efficiency as their guides can expect to save child lives in a cost-effective way. Funding Sources This work was funded by a grant from the Bill & Melinda Gates Foundation to the UC Davis, and by a gift from Mars Inc. to UC Davis to support interdisciplinary research and training in economics and nutrition.

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Cost-Effectiveness of Using Mass Media to Prevent Tobacco Use among Youth and Young Adults: The FinishIt Campaign

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224312 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4312

Author(s):

Elizabeth C. Hair ◽

David R. Holtgrave ◽

Alexa R. Romberg ◽

Morgane Bennett ◽

Jessica M. Rath ◽

...

Keyword(s):

Cost Effectiveness ◽

Mass Media ◽

Cost Savings ◽

Cost Effective ◽

Cost Utility ◽

Base Case ◽

Tobacco Prevention ◽

Prevention Campaign ◽

Program Costs ◽

The Cost

Mass media campaigns have been hailed as some of the most effective tobacco prevention interventions. This study examined the cost-effectiveness of the national tobacco prevention campaign, truth® FinishIt, to determine the cost per quality-adjusted life year (QALY) saved and the return on investment (ROI). The cost–utility analysis used four main parameters: program costs, number of smoking careers averted, treatment costs, and number of QALYs saved whenever a smoking career is averted. Parameters were varied to characterize cost-effectiveness under different assumptions (base case, conservative, optimistic, and most optimistic). The ROI estimate compared campaign expenditures to the cost saved due to the campaign implementation. Analyses were conducted in 2019. The base case analysis indicated the campaign results in a societal cost savings of $3.072 billion. Under the most conservative assumptions, estimates indicated the campaign was highly cost-effective at $1076 per QALY saved. The overall ROI estimate was $174 ($144 in costs to smokers, $24 in costs to the smoker’s family, and $7 in costs to society) in cost savings for every $1 spent on the campaign. In all analyses, the FinishIt campaign was found to reach or exceed the threshold levels of cost savings or cost-effectiveness, with a positive ROI. These findings point to the value of this important investment in the health of the younger generation.

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The Cost-Effectiveness of Existing and Hypothetical Iron Fortification Programs in Haiti

Current Developments in Nutrition ◽

10.1093/cdn/nzab045_003 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 621-621

Author(s):

Katherine Adams ◽

Stephen Vosti ◽

Michael Jarvis ◽

Yves-Laurent Régis ◽

Ruth Climat ◽

...

Keyword(s):

Cost Effectiveness ◽

Pregnant Women ◽

Wheat Flour ◽

Cost Effective ◽

The United States ◽

Reproductive Age ◽

Iron Fortification ◽

Iron Intake ◽

Effective Coverage ◽

The Cost

Abstract Objectives Our objectives were to estimate apparent intake of iron in Haiti, to assess the adequacy of iron intake among women of reproductive age (WRA), and to model the cost-effectiveness of fortifying alternative food vehicles for reducing inadequate intake. Methods We analyzed the most recent Haiti household food consumption data (2012 ECVMAS) to estimate adequacy of apparent iron intake from dietary sources (using the adult male equivalent method; assuming 10% absorption) and modeled the impacts of fortifying currently mandated (wheat flour, applying local data on current compliance) and hypothetical (bouillon and rice) food vehicles on reductions in the prevalence of inadequate iron intake (effective coverage). We built activity-based cost models to estimate large scale food fortification (LSFF) program establishment and management costs, based on key informant interviews and on published cost estimates from other settings adapted to fit the Haitian case. Results The prevalence of inadequate dietary intake of iron among WRA was 79% (100% among pregnant women). Iron-fortified wheat flour was the most cost-effective vehicle: $4.32 and $4.75 per WRA-year effectively covered at current (75% of flour fortified to the standard of 30 mg/kg) and target (90% fortified to the standard) fortification levels. Fortified wheat flour effectively covered 11–13% of non-pregnant WRA, but almost no pregnant women. Although bouillon was consumed by > 98% of households, low estimated iron absorption from fortified bouillon (2%) led to low effective coverage. Iron-fortified rice (90% fortified at 120 mg/kg) was predicted to effectively cover the largest number of WRA (reducing inadequate intake to ∼30%), but at a cost of $7.80 per WRA-year effectively covered. Conclusions Of the food vehicles modeled, wheat flour was the most cost-effective for reducing inadequate iron intake. Modeling iron fortification of individual and combinations of food vehicles showed that well-designed LSFF programs can contribute to improving iron status among non-pregnant women, but eliminating inadequate iron intake among all WRA will require complementary iron interventions. Funding Sources This work was supported by grants to UC Davis from the Global Alliance for Improved Nutrition (GAIN) and to Partners of the Americas from the United States Agency for International Development (USAID).

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Assessing cost-effectiveness of hepatitis C testing pathways in Georgia using the Hep C Testing Calculator

Scientific Reports ◽

10.1038/s41598-021-00362-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Madeline Adee ◽

Yueran Zhuo ◽

Huaiyang Zhong ◽

Tiannan Zhan ◽

Rakesh Aggarwal ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis C ◽

Cost Saving ◽

Cost Effective ◽

Current Standard ◽

Lifetime Horizon ◽

Soc Testing ◽

Program Costs ◽

The Cost ◽

Hcv Testing

AbstractThe cost of testing can be a substantial contributor to hepatitis C virus (HCV) elimination program costs in many low- and middle-income countries such as Georgia, resulting in the need for innovative and cost-effective strategies for testing. Our objective was to investigate the most cost-effective testing pathways for scaling-up HCV testing in Georgia. We developed a Markov-based model with a lifetime horizon that simulates the natural history of HCV, and the cost of detection and treatment of HCV. We then created an interactive online tool that uses results from the Markov-based model to evaluate the cost-effectiveness of different HCV testing pathways. We compared the current standard-of-care (SoC) testing pathway and four innovative testing pathways for Georgia. The SoC testing was cost-saving compared to no testing, but all four new HCV testing pathways further increased QALYs and decreased costs. The pathway with the highest patient follow-up, due to on-site testing, resulted in the highest discounted QALYs (123 QALY more than the SoC) and lowest costs ($127,052 less than the SoC) per 10,000 persons screened. The current testing algorithm in Georgia can be replaced with a new pathway that is more effective while being cost-saving.

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A Cost-Effectiveness Analysis of Pediatric Intraosseous Infusion as a Prehospital Skill

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00039546 ◽

1992 ◽

Vol 7 (3) ◽

pp. 221-227 ◽

Cited By ~ 1

Author(s):

Herbert G. Garrison ◽

Stephen M. Downs ◽

Robert A. McNutt ◽

Thomas R. Griggs

Keyword(s):

Cost Effectiveness ◽

Clinical Efficacy ◽

Vascular Access ◽

Cost Effective ◽

Epidemiologic Studies ◽

Decision Analytic Model ◽

Cost Effectiveness Ratio ◽

Number Of Patients ◽

Program Costs ◽

The Cost

AbstractPurpose:To determine the clinical efficacy, patient volume, and program costs that justify pediatric intraosseous (IO) infusion as a routine skill for the treatment of patients with cardiac arrest in a prehospital system.Methods:A decision analytic model was constructed to include patient outcomes and costs to society. Critical variables for the analysis were: 1) time to vascular access; 2) success of vascular access; 3) clinical efficacy (i.e., the percentage of lives saved by early vascular access); 4) number of patients requiring IO annually; and 5) the cost of an IO program. Program costs included training and equipment expenses. Sensitivity analysis, which repeatedly evaluates the model using different values for the critical variables, identified those values at which IO would be cost-effective.Results:With an estimated 80% success rate for IO access within five minutes, the cost-per-life-saved would be [US] $161,000. This cost-effectiveness ratio assumed annual program expenses of $2,000 and one patient per year needing IO. The cost-effectiveness ratio also required a clinical efficacy of 2% for vascular access. To prove that the clinical efficacy of vascular access is in fact 2%, epidemiologic studies would require a sample of nearly 9,000 patients.Conclusions:This analysis suggests IO probably is cost-effective given a clinical efficacy above 2%. While the true efficacy may be below this value, clinical studies are unlikely to have sufficient size to prove it. Therefore, emergency medical services (EMS) medical directors must make the decision to utilize IO based on their own beliefs about its clinical efficacy. Further, it must be considered in the context of other prehospital programs which may be more cost-effective. Such analyses permit establishment of rational priorities to rank programs in prehospital systems.

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Spotting the Differences: The CEAC vs. CEAFC vs. CERAC

10.20944/preprints202109.0055.v1 ◽

2021 ◽

Author(s):

Pedram Sendi ◽

Klazien Matter-Walstra ◽

Matthias Schwenkglenks

Keyword(s):

Cost Effectiveness ◽

Risk Aversion ◽

Joint Distribution ◽

Joint Probability ◽

Cost Effective ◽

Policy Makers ◽

North East ◽

The North ◽

Program Costs ◽

The Cost

Methods to handle uncertainty in economic evaluation have gained much attention in the literature and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarize and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasized the limitations of the CEAC for informing decision and policy makers as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is therefore sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention as it estimates the joint probability an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows to incorporate risk-aversion into the analysis and can therefore be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC and show how these can jointly be used to inform decision and policy makers.

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Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study

Vaccines ◽

10.3390/vaccines8040707 ◽

2020 ◽

Vol 8 (4) ◽

pp. 707

Author(s):

Afifah Machlaurin ◽

Franklin Christiaan Karel Dolk ◽

Didik Setiawan ◽

Tjipke Sytse van der Werf ◽

Maarten J. Postma

Keyword(s):

Cost Effectiveness ◽

Univariate Analysis ◽

Cost Effective ◽

Epidemiological Data ◽

Control Programme ◽

Detection Rates ◽

Middle Income ◽

Bcg Vaccination ◽

Life Years ◽

The Cost

Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries.

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Cost Effectiveness of Transbronchial Needle Aspiration

Canadian Respiratory Journal ◽

10.1155/1999/508741 ◽

1999 ◽

Vol 6 (4) ◽

pp. 332-335 ◽

Cited By ~ 14

Author(s):

Jennifer A Crocket ◽

Eric YL Wong ◽

Dale C Lien ◽

Khanh Gia Nguyen ◽

Michelle R Chaput ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Diagnostic Procedures ◽

Needle Aspiration ◽

Benign Disease ◽

University Hospital ◽

High Yield ◽

Transbronchial Needle Aspiration ◽

Computed Tomographic ◽

The Cost

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

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The cost-effectiveness of insulin analogs and regular insulin for diabetes control: a case study in Iran

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-02-2019-0042 ◽

2020 ◽

Vol 33 (4/5) ◽

pp. 323-331

Author(s):

Mohsen pakdaman ◽

Raheleh akbari ◽

Hamid reza Dehghan ◽

Asra Asgharzadeh ◽

Mahdieh Namayandeh

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Regular Insulin ◽

Diabetes Control ◽

Diabetic Patients ◽

Insulin Analogs ◽

Content Type ◽

Patients With Diabetes ◽

The Government ◽

The Cost

PurposeFor years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017.Design/methodology/approachIn this descriptive–analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective.FindingsQALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.Originality/valueThis study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

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Screening for Melanoma by Primary Health Care Physicians: A Cost—Effectiveness Analysis

Journal of Medical Screening ◽

10.1177/096914139600300112 ◽

1996 ◽

Vol 3 (1) ◽

pp. 47-53 ◽

Cited By ~ 50

Author(s):

Afaf Girgis ◽

Philip Clarke ◽

Robert C Burton ◽

Rob W Sanson—Fisher

Keyword(s):

Cost Effectiveness ◽

Screening Programme ◽

Cost Effective ◽

Economic Assessment ◽

Screening Tests ◽

Family Practitioners ◽

Effectiveness Analysis ◽

The Cost ◽

Primary Health Care Physicians ◽

Melanoma Screening

Background and design— Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost—effectiveness estimates of melanoma screening were calculated. Results— Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening. Conclusion— The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.

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