scholarly journals Cost-effectiveness of remdesivir and dexamethasone for COVID-19 treatment in South Africa

2021 ◽  
Author(s):  
Youngji Jo ◽  
Lise Jamieson ◽  
Ijeoma Edoka ◽  
Lawrence Long ◽  
Sheetal Silal ◽  
...  
Keyword(s):  
South Africa ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
South African ◽  
Recovery Time ◽  
Standard Care ◽  
System Perspective ◽  
Uncertainty Range ◽  
Time Required ◽  
Ventilated Patients

Abstract Background Dexamethasone and remdesivir have the potential to reduce COVID-related mortality or recovery time, but their cost-effectiveness in countries with limited intensive care resources is unknown. Methods We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed cost-effectiveness of 1) administration of dexamethasone to ventilated patients and remdesivir to non-ventilated patients, 2) dexamethasone alone to both non-ventilated and ventilated patients, 3) remdesivir to non-ventilated patients only, and 4) dexamethasone to ventilated patients only; all relative to a scenario of standard care. We estimated costs from the healthcare system perspective in 2020 USD, deaths averted, and the incremental cost effectiveness ratios of each scenario. Results Remdesivir for non-ventilated patients and dexamethasone for ventilated patients was estimated to result in 408 [uncertainty range: 229-1891] deaths averted (assuming no efficacy [uncertainty range: 0-70%] of remdesivir) compared to standard care, and save $15 million. The result was driven by the efficacy of dexamethasone, and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone to non-ventilated and ventilated patients requires additional $159,000 and averts 689 [uncertainty range: 330-1118] deaths, resulting in $231 per death averted, relative to standard care. Conclusions The use of remdesivir for non-ventilated patients and dexamethasone for ventilated is likely to be cost-saving compared to standard care by reducing ICU days. Further efforts to improve recovery time with remdesivir and dexamethasone in ICU could save lives and costs in South Africa.

scholarly journals Cost-effectiveness of remdesivir and dexamethasone for COVID-19 treatment in South Africa

2020 ◽  
Author(s):  
Youngji Jo ◽  
Lise Jamieson ◽  
Ijeoma Edoka ◽  
Lawrence Long ◽  
Sheetal Silal ◽  
...  
Keyword(s):  
South Africa ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
South African ◽  
Standard Care ◽  
System Perspective ◽  
Healthcare System Perspective ◽  
Resource Limited ◽  
Time Required ◽  
Ventilated Patients

Background South Africa recently experienced a first peak in COVID-19 cases and mortality. Dexamethasone and remdesivir both have the potential to reduce COVID-related mortality, but their cost-effectiveness in a resource-limited setting with scant intensive care resources is unknown. Methods We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed cost-effectiveness of 1) administration of dexamethasone to ventilated patients and remdesivir to non-ventilated patients, 2) dexamethasone alone to both non-ventilated and ventilated patients, 3) remdesivir to non-ventilated patients only, and 4) dexamethasone to ventilated patients only; all relative to a scenario of standard care. We estimated costs from the healthcare system perspective in 2020 USD, deaths averted, and the incremental cost effectiveness ratios of each scenario. Results Remdesivir for non-ventilated patients and dexamethasone for ventilated patients was estimated to result in 1,111 deaths averted (assuming a 0-30% efficacy of remdesivir) compared to standard care, and save $11.5 million. The result was driven by the efficacy of the drugs, and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone to ventilated and non-ventilated patients requires additional $159,000 and averts 1,146 deaths, resulting in $139 per death averted, relative to standard care. Conclusions The use of dexamethasone for ventilated and remdesivir for non-ventilated patients is likely to be cost-saving compared to standard care. Given the economic and health benefits of both drugs, efforts to ensure access to these medications is paramount.

Cost-Effectiveness of Skin Surveillance Through a Specialized Clinic for Patients at High Risk of Melanoma

2017 ◽  
Vol 35 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Caroline G. Watts ◽  
Anne E. Cust ◽  
Scott W. Menzies ◽  
Graham J. Mann ◽  
Rachael L. Morton
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Standard Care ◽  
Sensitivity Analyses ◽  
Model Parameters ◽  
System Perspective ◽  
Life Years ◽  
The Mean ◽  
Quality Adjusted Life ◽  
High Risk Clinic

Purpose Clinical guidelines recommend that people at high risk of melanoma receive regular surveillance to improve survival through early detection. A specialized High Risk Clinic in Sydney, Australia was found to be effective for this purpose; however, wider implementation of this clinical service requires evidence of cost-effectiveness and data addressing potential overtreatment of suspicious skin lesions. Patients and Methods A decision-analytic model was built to compare the costs and benefits of specialized surveillance compared with standard care over a 10-year period, from a health system perspective. A high-risk standard care cohort was obtained using linked population data, comprising the Sax Institute’s 45 and Up cohort study, linked to Medicare Benefits Schedule claims data, the cancer registry, and hospital admissions data. Benefits were measured in quality-adjusted life-years gained. Sensitivity analyses were undertaken for all model parameters. Results Specialized surveillance through the High Risk Clinic was both less expensive and more effective than standard care. The mean saving was A$6,828 (95% CI, $5,564 to $8,092) per patient, and the mean quality-adjusted life-year gain was 0.31 (95% CI, 0.27 to 0.35). The main drivers of the differences were detection of melanoma at an earlier stage resulting in less extensive treatment and a lower annual mean excision rate for suspicious lesions in specialized surveillance (0.81; 95% CI, 0.72 to 0.91) compared with standard care (2.55; 95% CI, 2.34 to 2.76). The results were robust when tested in sensitivity analyses. Conclusion Specialized surveillance was a cost-effective strategy for the management of individuals at high risk of melanoma. There were also fewer invasive procedures in specialized surveillance compared with standard care in the community.

scholarly journals Enhanced recovery programme for open liver resection improves hospital costs and two-year survival without increasing costs in primary care. (Preprint)

2019 ◽  
Author(s):  
Chris N Jones ◽  
Ben L Morrison ◽  
Leigh J S Kelliher ◽  
Matthew Dickinson ◽  
Michael Scott ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Liver Resection ◽  
Standard Care ◽  
Enhanced Recovery ◽  
Study Endpoint ◽  
Term Survival ◽  
System Perspective ◽  
Open Liver Resection ◽  
Life Years ◽  
The Cost

BACKGROUND The clinical benefits of enhanced recovery programmes [ERPs] have been extensively researched, but few studies have evaluated the cost-effectiveness of programmes. This study follows on from a previous randomised controlled trial. OBJECTIVE To evaluate the cost-effectiveness and impaxct upon long-term survival of an enhanced recovery after surgery programme for patients undergoing open liver resection surgery. METHODS A decision-analytic model was used to compare the study endpoint Enhanced Recovery versus standard care provided to patient with open liver resection. Outcomes obtained were costs per life-years gained. Resource use and costs were estimated from the National Health System perspective. The Decision tree and Markov Model were constructed using the original results and augmented by external data of published clinical trials. RESULTS Patients receiving Enhanced Recovery had an average life expectancy of 6.9 years versus 6.1 years in the standard group. Costs were 9538.279 GBP for ERP and 14793.05 GBP for standard treatment. This results in a cost-effectiveness ratio of -6748.33 GBP/QALY. Patients required fewer visits to their GP (p=0.006) and required less help at home with day to day activities (p=0.036). Survival at 2 years was 91.3% (ERP) vs 71.3% for the standard care group (p=0.03). CONCLUSIONS Enhanced Recovery for open liver resection can improve medium-term survival and is cost effective for both hospital and community settings. CLINICALTRIAL ISRCTN03274575 - http://www.controlled-trials.com

scholarly journals Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation

2013 ◽  
Vol 17 (9) ◽  
pp. 2138-2145 ◽  
Author(s):  
Meera K Chhagan ◽  
Jan Van den Broeck ◽  
Kany-Kany Angelique Luabeya ◽  
Nontobeko Mpontshane ◽  
Michael L Bennish
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Vitamin A ◽  
South African ◽  
Secondary Data ◽  
Cost Effective ◽  
Data Sources ◽  
Rural South ◽  
Secondary Data Sources ◽  
The Cost

AbstractObjectiveTo describe the cost of diarrhoeal illness in children aged 6–24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea.DesignWe conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence.SettingData on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources.SubjectsThe trial included children aged 6–24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database.ResultsIn the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels.ConclusionsThis simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

scholarly journals An individually randomized controlled trial of a mother-daughter HIV/STI prevention program for adolescent girls and young women in South Africa: IMARA-SA study protocol

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Geri R. Donenberg ◽  
Millicent Atujuna ◽  
Katherine G. Merrill ◽  
Erin Emerson ◽  
Sheily Ndwayana ◽  
...  
Keyword(s):  
South Africa ◽  
Randomized Controlled Trial ◽  
Cost Effectiveness ◽  
South African ◽  
Adolescent Girls ◽  
Young Women ◽  
Prevention Program ◽  
Controlled Trial ◽  
Sti Prevention ◽  
Randomized Controlled

Abstract Background South Africa has the world’s largest HIV epidemic, but South African adolescent girls and young women (AGYW) acquire HIV at twice the rate of and seroconvert on average 5–7 years earlier than their male peers. Female caregivers (FC) are an untapped resource for HIV/STI prevention in South Africa and offer a novel opportunity to strengthen AGYW prevention efforts. This study will evaluate the effectiveness and cost-effectiveness of an evidence-based mother-daughter HIV/STI prevention program tested in the United States and adapted for South Africa, Informed Motivated Aware and Responsible Adolescents and Adults (IMARA), to decrease STI incident infections and increase HIV testing and counseling (HTC) and PrEP uptake in AGYW. Methods This is a 2-arm individually randomized controlled trial comparing IMARA to a family-based control program matched in time and intensity with 525 15–19-year-old Black South African AGYW and their FC-dyads in Cape Town’s informal communities. AGYW will complete baseline, 6-, and 12-month assessments. Following randomization, AGYW-FC dyads will participate in a 2-day group workshop (total 10 h) that includes joint and separate mother and daughter activities. Primary outcomes are AGYW STI incidence, HTC uptake, and PrEP uptake at 6 months. Secondary outcomes are AGYW STI incidence, HTC uptake, and PrEP uptake at 12 months, sexual behavior (e.g., condom use, number of partners), HIV incidence, and ART/PrEP adherence and intervention cost-effectiveness. AGYW who test positive for a STI will receive free treatment at the study site. HIV positive participants will be referred to ART clinics. Discussion Primary prevention remains the most viable strategy to stem new STI and HIV transmissions. HIV and STI disparities go beyond individual level factors, and prevention packages that include supportive relationships (e.g., FC) may produce greater reductions in HIV-risk, improve HTC and PrEP uptake, and increase linkage, retention, and adherence to care. Reducing new HIV and STI infections among South African AGYW is global public health priority. Trial registration ClinicalTrials.gov Number NCT04758390, accepted 02/16/2021.

scholarly journals Intensive Care Utilisation: The Baragwanath Experience

1993 ◽  
Vol 21 (4) ◽  
pp. 396-399 ◽  
Author(s):  
P. E. Marik ◽  
P. Kraus ◽  
J. Lipman
Keyword(s):  
South Africa ◽  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
Intensive Care Medicine ◽  
Health Care System ◽  
Quality Cost ◽  
Care Utilisation

Intensive care medicine is an expensive service whose impact on health care has been questioned. South Africa is a country undergoing rapid social and political change and the role of intensive care medicine in the health care system of this country needs to be assessed. In this paper we evaluated the quality, cost-effectiveness and utilisation of technology in the intensive care unit of Baragwanath Hospital, a hospital serving the black community of Soweto.

PP138 Cost-Effectiveness Analysis Of Influenza A (H1N1) Chemoprophylaxis

2018 ◽  
Vol 34 (S1) ◽  
pp. 120-121
Author(s):  
Luisa Vecoso ◽  
Marcus Silva ◽  
Everton Silva ◽  
Mariangela Resende ◽  
Tais Galvao
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Incremental Cost ◽  
Health Care System ◽  
Influenza A ◽  
System Perspective ◽  
Influenza A H1n1 ◽  
Care System

Introduction:Influenza A (H1N1) virus is the most relevant virus in death by flu complications. Oseltamivir and zanamivir are used for influenza prophylaxis in epidemics. We aimed to evaluate the efficacy of chemoprophylaxis for influenza A (H1N1) for the Brazilian health care system.Methods:We systematically searched the literature to identify efficacy results. Costs assessed from the system perspective were obtained from official Brazilian Ministry of Health systems, and completed from medical care at a university hospital of Campinas, Sao Paulo. Model outcomes were quality-adjusted life years (QALY) with willingness to pay BRL 30,000 (USD 8,212)/QALY and prevention of H1N1. A decision-tree model was used to calculate the incremental cost-effectiveness ratios for prophylaxis, compared to no prophylaxis. Deterministic and probabilistic sensitivity analyses were used to test robustness of the model.Results:Prophylaxis had 70 percent adherence to treatment, 9 percent adverse events, effectiveness in avoiding H1N1 (relative risk = 0.43; 95% confidence interval: 0.33, 0.57); no evidence of prophylaxis efficacy for complication, hospitalization and death was found. Both scenarios had 14 percent H1N1 attack rate, 67 percent of ambulatorial consult, 43 percent of inpatient care, 14 percent of deaths in hospital, 23 percent of intensive care where death was 40 percent. Utility was 0.50 during H1N1 infection, 0.23 with hospitalization, 0.195 less with adverse events, 0 for deaths and 0.885 for healthy. Cost was BRL39 (USD 11) for chemoprophylaxis; BRL 12 (USD 4) for outpatient care; BRL 5,728 (USD 1,568) for hospital admission; BRL 19,217 (USD 5,260) for intensive care; and BRL 292 (USD 80) for adverse events. Incremental cost of prophylaxis was BRL 40 (USD 11) and utility increased 0.004, which mean saving of BRL 2,921 (USD 780)/QALY. Prophylaxis saves BRL 338 (USD 92) per H1N1 case avoided. Univariate and probabilistic sensitivity analysis assure the robustness of results, with 43 percent probability of being of lower cost and higher effectiveness.Conclusions:Prophylaxis is cost-effective from the health care system perspective using utility and avoided H1N1 cases outcomes.

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