scholarly journals Cost of a new method of active screening for human African trypanosomiasis in the Democratic Republic of the Congo

2020 ◽  
Author(s):  
Rian Snijders ◽  
Alain Fukinsia ◽  
Yves Claeys ◽  
Alain Mpanya ◽  
Epco Hasker ◽  
...  
Keyword(s):  
Human African Trypanosomiasis ◽  
Democratic Republic ◽  
Public Health Problem ◽  
Cost Effective ◽  
Active Case Finding ◽  
Active Screening ◽  
Populations At Risk ◽  
Republic Of The Congo ◽  
Cost Effective Alternative ◽  
The Cost

ABSTRACTBackgroundHuman African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease that killed thousands of people at the start of the 20th century. Today, less than 1,000 cases are reported globally, and the disease is targeted for elimination and eradication. One of the main disease control strategies is active case-finding through outreach campaigns. In 2014, a new method for active screening was developed with mini, motorcycle-based, teams. This study aims to compare the cost of two approaches for active HAT screening, namely the traditional mobile teams and mini mobile teams.MethodsWe estimated annual economic costs for the two active HAT screening approaches from a health care provider perspective. Cost and operational data was collected for 12 months for 1 traditional team and 3 mini teams in the health districts of Yasa Bonga and Mosango in the Kwilu province of the Democratic Republic of the Congo. The cost per person screened and per person diagnosed was calculated. Univariate sensitivity analysis was conducted on important cost drivers.ResultsThe study shows that the cost per person screened is lower for a mini team compared to a traditional team in the study setting (US$1.86 compared to US$2.08) as well as in a simulation analysis assuming both teams would operate in a setting with similar disease prevalence.DiscussionActive HAT screening with mini mobile teams has a lower cost and could be a cost-effective alternative for active screening campaigns. Further research is needed to determine if mini mobile teams have similar or better yields than traditional mobile teams in terms of detections and cases successfully treated.AUTHOR SUMMARYHuman African Trypanosomiasis (HAT) used to be a major public health problem in Sub-Saharan Africa, but the disease is becoming less frequent today as a result of sustained control efforts. Currently, the elimination of sleeping sickness is targeted as a public health problem by 2020 with interruption of transmission by 2030. To achieve these targets, a long-term commitment towards HAT control activities will be necessary with innovative disease control approaches accompanied by economic evaluations to assess their cost and cost-effectiveness in the changing context. Today, active case finding conducted through mass outreach campaigns accounts for approximately half of all identified cases in the Democratic Republic of the Congo. However, this strategy has become less efficient, with a dwindling “yield” in terms of the number of identified cases, translating to a higher cost per diagnosed HAT case. Therefore, different approaches to outreach campaigns need to be evaluated with a focus on reaching populations at risk for HAT.This article presents the costs and outcomes of two approaches to active screening: traditional mobile teams and mini mobile teams.This study shows that mini mobile teams could be a cost-effective alternative for active screening with a cost-per-person screened of US$1.86 compared to US$2.08. This approach could increase the screening coverage of populations at risk for HAT that are currently not being reached through the traditional approach. Future research is needed to evaluate the difference in HAT cases identified and treated by both approaches. This would allow a cost-effectiveness comparison of both strategies based on the cost-per-person diagnosed and treated.

scholarly journals Cost of a new method of active screening for human African trypanosomiasis in the Democratic Republic of the Congo

2020 ◽  
Vol 14 (12) ◽  
pp. e0008832
Author(s):  
Rian Snijders ◽  
Alain Fukinsia ◽  
Yves Claeys ◽  
Alain Mpanya ◽  
Epco Hasker ◽  
...  
Keyword(s):  
Lower Cost ◽  
Democratic Republic ◽  
Capillary Tube ◽  
Case Finding ◽  
New Method ◽  
Active Case Finding ◽  
Active Screening ◽  
Active Case ◽  
Republic Of The Congo ◽  
The Cost

Background Human African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease targeted for eradication. One of the main disease control strategies is active case-finding through outreach campaigns. In 2014, a new method for active screening was developed with mini, motorcycle-based, teams. This study compares the cost of two active case-finding approaches, namely the traditional mobile teams and mini mobile teams, in the two health districts of the Democratic Republic of the Congo. Methods The financial and economic costs of both approaches were estimated from a health care provider perspective. Cost and operational data were collected for 12 months for 1 traditional team and 3 mini teams. The cost per person screened and diagnosed was calculated and univariate sensitivity analysis was conducted to identify the main cost drivers. Results During the study period in total 264,630 people were screened, and 23 HAT cases detected. The cost per person screened was lower for a mini team than for a traditional team in the study setting (US$1.86 versus US$2.08). A comparable result was found in a scenario analysis, assuming both teams would operate in a similar setting, with the cost per person screened by a mini team 15% lower than the cost per person screened by a traditional team (1.86 $ vs 2.14$). The main explanations for this lower cost are that mini teams work with fewer human resources, cheaper means of transportation and do not perform the Capillary Tube Centrifugation test or card agglutination test dilutions. Discussion Active HAT screening with mini mobile teams has a lower cost and could be a cost-effective alternative for active case-finding. Further research is needed to determine if mini mobile teams have similar or better yields than traditional mobile teams in terms of detections and cases successfully treated.

scholarly journals Cost-effectiveness modelling to optimise active screening strategy for gambiense human African trypanosomiasis in endemic areas of the Democratic Republic of Congo

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Christopher N. Davis ◽  
Kat S. Rock ◽  
Marina Antillón ◽  
Erick Mwamba Miaka ◽  
Matt J. Keeling
Keyword(s):  
Cost Effectiveness ◽  
Human African Trypanosomiasis ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Cost Effective ◽  
African Trypanosomiasis ◽  
Republic Of Congo ◽  
Active Screening ◽  
Screening Strategies ◽  
Annual Screening

Abstract Background Gambiense human African trypanosomiasis (gHAT) has been brought under control recently with village-based active screening playing a major role in case reduction. In the approach to elimination, we investigate how to optimise active screening in villages in the Democratic Republic of Congo, such that the expenses of screening programmes can be efficiently allocated whilst continuing to avert morbidity and mortality. Methods We implement a cost-effectiveness analysis using a stochastic gHAT infection model for a range of active screening strategies and, in conjunction with a cost model, we calculate the net monetary benefit (NMB) of each strategy. We focus on the high-endemicity health zone of Kwamouth in the Democratic Republic of Congo. Results High-coverage active screening strategies, occurring approximately annually, attain the highest NMB. For realistic screening at 55% coverage, annual screening is cost-effective at very low willingness-to-pay thresholds (<DOLLAR/>20.4 per disability adjusted life year (DALY) averted), only marginally higher than biennial screening (<DOLLAR/>14.6 per DALY averted). We find that, for strategies stopping after 1, 2 or 3 years of zero case reporting, the expected cost-benefits are very similar. Conclusions We highlight the current recommended strategy—annual screening with three years of zero case reporting before stopping active screening—is likely cost-effective, in addition to providing valuable information on whether transmission has been interrupted.

scholarly journals OP0198-HPR A STRUCTURED MODEL FOR OA CARE IN PRIMARY HEALTHCARE IS A COST-EFFECTIVE ALTERNATIVE COMPARED TO USUAL CARE FOR PEOPLE WITH HIP AND KNEE OA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 119-120
Author(s):  
N. Østerås ◽  
E. Aas ◽  
T. Moseng ◽  
L. Van Bodegom-Vos ◽  
K. Dziedzic ◽  
...  
Keyword(s):  
Usual Care ◽  
Primary Healthcare ◽  
Intervention Group ◽  
Cost Effective ◽  
Cost Utility ◽  
Control Group ◽  
Structured Model ◽  
Knee Oa ◽  
Cost Effective Alternative ◽  
The Cost

Background:To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international treatment recommendations. A previous analysis of a cluster RCT (cRCT) showed that compared to usual care, the intervention group reported higher quality of care and greater satisfaction with care. Also, more patients were treated according to international guidelines and fulfilled recommendations for physical activity at the 6-month follow-up.Objectives:To assess the cost-utility of a structured model for hip or knee OA care.Methods:A cRCT with stepped-wedge cohort design was conducted in 6 Norwegian municipalities (clusters) in 2015-17. The OA care model was implemented in one cluster at the time by switching from “usual care” to the structured model. The implementation of the model was facilitated by interactive workshops for general practitioners (GPs) and physiotherapists (PTs) with an update on OA treatment recommendations. The GPs explained the OA diagnosis and treatment alternatives, provided pharmacological treatment when appropriate, and suggested referral to physiotherapy. The PT-led patient OA education programme was group-based and lasted 3 hours followed by an 8–12-week individually tailored resistance exercise programme with twice weekly 1-hour supervised group sessions (5–10 patients per PT). An optional 10-hours Healthy Eating Program was available. Participants were ≥45 years with symptomatic hip or knee OA.Costs were measured from the healthcare perspective and collected from several sources. Patients self-reported visits in primary healthcare at 3, 6, 9 and 12 months. Secondary healthcare visits and joint surgery data were extracted from the Norwegian Patient Register. The health outcome, quality-adjusted life-year (QALY), was estimated based on the EQ-5D-5L scores at baseline, 3, 6, 9 and 12 months. The result of the cost-utility analysis was reported using the incremental cost-effectiveness ratio (ICER), defined as the incremental costs relative to incremental QALYs (QALYs gained). Based on Norwegian guidelines, the threshold is €27500. Sensitivity analyses were performed using bootstrapping to assess the robustness of reported results and presented in a cost-effectiveness plane (Figure 1).Results:The 393 patients’ mean age was 63 years (SD 9.6) and 74% were women. 109 patients were recruited during control periods (control group), and 284 patients were recruited during interventions periods (intervention group). Only the intervention group had a significant increase in EQ-5D-5L utility scores from baseline to 12 months follow-up (mean change 0.03; 95% CI 0.01, 0.05) with QALYs gained: 0.02 (95% CI -0.08, 0.12). The structured OA model cost approx. €301 p.p. with an additional €50 for the Healthy Eating Program. Total 12 months healthcare cost p.p. was €1281 in the intervention and €3147 in the control group, resulting in an incremental cost of -€1866 (95% CI -3147, -584) p.p. Costs related to surgical procedures had the largest impact on total healthcare costs in both groups. During the 12-months follow-up period, 5% (n=14) in the intervention compared to 12% (n=13) in the control group underwent joint surgery; resulting in a mean surgical procedure cost of €553 p.p. in the intervention as compared to €1624 p.p. in the control group. The ICER was -€93300, indicating that the OA care model resulted in QALYs gained and cost-savings. At a threshold of €27500, it is 99% likely that the OA care model is a cost-effective alternative.Conclusion:The results of the cost-utility analysis show that implementing a structured model for OA care in primary healthcare based on international guidelines is highly likely a cost-effective alternative compared to usual care for people with hip and knee OA. More studies are needed to confirm this finding, but this study results indicate that implementing structured OA care models in primary healthcare may be beneficial for the individual as well as for the society.Disclosure of Interests:None declared

scholarly journals Optical spin-symmetry breaking for high-efficiency directional helicity-multiplexed metaholograms

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Muhammad Ashar Naveed ◽  
Muhammad Afnan Ansari ◽  
Inki Kim ◽  
Trevon Badloe ◽  
Joohoon Kim ◽  
...  
Keyword(s):  
High Efficiency ◽  
Spin Symmetry ◽  
Cost Effective ◽  
Dielectric Materials ◽  
Additional Degree ◽  
Cost Effective Alternative ◽  
Spin Orbit Interactions ◽  
Smart Mobile ◽  
The Cost ◽  
Hydrogenated Amorphous

AbstractHelicity-multiplexed metasurfaces based on symmetric spin–orbit interactions (SOIs) have practical limits because they cannot provide central-symmetric holographic imaging. Asymmetric SOIs can effectively address such limitations, with several exciting applications in various fields ranging from asymmetric data inscription in communications to dual side displays in smart mobile devices. Low-loss dielectric materials provide an excellent platform for realizing such exotic phenomena efficiently. In this paper, we demonstrate an asymmetric SOI-dependent transmission-type metasurface in the visible domain using hydrogenated amorphous silicon (a-Si:H) nanoresonators. The proposed design approach is equipped with an additional degree of freedom in designing bi-directional helicity-multiplexed metasurfaces by breaking the conventional limit imposed by the symmetric SOI in half employment of metasurfaces for one circular handedness. Two on-axis, distinct wavefronts are produced with high transmission efficiencies, demonstrating the concept of asymmetric wavefront generation in two antiparallel directions. Additionally, the CMOS compatibility of a-Si:H makes it a cost-effective alternative to gallium nitride (GaN) and titanium dioxide (TiO2) for visible light. The cost-effective fabrication and simplicity of the proposed design technique provide an excellent candidate for high-efficiency, multifunctional, and chip-integrated demonstration of various phenomena.

scholarly journals Comparison of platforms for testing antibodies to Chlamydia trachomatis antigens in the Democratic Republic of the Congo and Togo

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sarah Gwyn ◽  
Marcel S. Awoussi ◽  
Ana Bakhtiari ◽  
Rachel N. Bronzan ◽  
Kathryn Crowley ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Democratic Republic ◽  
Seroconversion Rate ◽  
Public Health Problem ◽  
Dried Blood Spots ◽  
Ocular Infection ◽  
Republic Of The Congo ◽  
Lateral Flow Assays ◽  
Serological Data ◽  
Multiplex Bead

AbstractTrachoma, caused by repeated ocular infection with Chlamydia trachomatis (Ct), is targeted for elimination as a public health problem. Serological testing for antibodies is promising for surveillance; determining useful thresholds will require collection of serological data from settings with different prevalence of the indicator trachomatous inflammation—follicular (TF). Dried blood spots were collected during trachoma mapping in two districts each of Togo and Democratic Republic of the Congo. Anti-Ct antibodies were detected by multiplex bead assay (MBA) and three different lateral flow assays (LFA) and seroprevalence and seroconversion rate (SCR) were determined. By most tests, the district with > 5% TF (the elimination threshold) had five–sixfold higher seroprevalence and tenfold higher SCR than districts with < 5% TF. The agreement between LFA and MBA was improved using a black latex developing reagent. These data show optimization of antibody tests against Ct to better differentiate districts above or below trachoma elimination thresholds.

An Innovative Cost-Effective Approach for Characterization of Removable Prosthesis - Case Series

2021 ◽  
Author(s):  
Tushar
Keyword(s):  
Case Series ◽  
Cost Effective ◽  
Functional Rehabilitation ◽  
Denture Base ◽  
Cost Effective Approach ◽  
Removable Denture ◽  
Removable Prosthesis ◽  
Cost Effective Alternative ◽  
The Aesthetic ◽  
The Cost

Esthetics plays a crucial role in rehabilitation of removable dentures to achieve a pleasant smile. Denture esthetics is the effect produced, which improves the beauty and attractiveness of a person. With the advances of implants and ceramics, the conventional removable denture needs to be updated. denture characterization is a must in avoiding denture look and giving natural look. Giving the prosthesis as close as possible to the natural apparatus before the tooth loss is the key to a successful prosthetic, esthetic and functional rehabilitation. As a prosthodontist dealing in fulfilling the aesthetic challenges an economical alternative to high-end costly procedures is a must considering the Indian scenario, keeping in mind the biocompatibility and longevity of the treatment. As per literature light cure, gum staining is one of the techniques for masking denture base color and imparting natural color to mucosa but considering the cost involved many patients requiring aesthetic enhancement of prosthesis avoid going for such treatment thereby compromising their aesthetic. the present case series describe an innovative cost-effective alternative to the previously describe technique for masking the denture base color by using composite mixed with stains to replicate the natural apparatus.

scholarly journals Cost–effectiveness and cost-benefit analysis of oliceridine in the treatment of acute pain

2021 ◽  
Author(s):  
Kit N Simpson ◽  
Michael J Fossler ◽  
Linda Wase ◽  
Mark A Demitrack
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Cost Effective ◽  
Adverse Outcomes ◽  
Protein Signaling ◽  
Opioid Receptor Agonist ◽  
Cost Effective Alternative ◽  
Μ Opioid Receptor ◽  
The Cost

Aim: Oliceridine, a new class of μ-opioid receptor agonist, is selective for G-protein signaling (analgesia) with limited recruitment of β-arrestin (associated with adverse outcomes) and may provide a cost-effective alternative versus conventional opioid morphine for postoperative pain. Patients & methods: Using a decision tree with a 24-h time horizon, we calculated costs for medication and management of three most common adverse events (AEs; oxygen saturation <90%, vomiting and somnolence) following postoperative oliceridine or morphine use. Results: Using oliceridine, the cost for managing AEs was US$528,424 versus $852,429 for morphine, with a net cost savings of $324,005. Conclusion: Oliceridine has a favorable overall impact on the total cost of postoperative care compared with the use of the conventional opioid morphine.

scholarly journals Long-acting porcine sequence ACTH in the diagnosis of adrenal insufficiency: a cost-effective alternative to the ACTH1–24 test

2020 ◽  
Vol 182 (2) ◽  
pp. C5-C7
Author(s):  
Warrick J Inder
Keyword(s):  
Developing Countries ◽  
Adrenal Insufficiency ◽  
Diagnostic Performance ◽  
Cost Effective ◽  
Effective Alternative ◽  
Secondary Adrenal Insufficiency ◽  
Robust Test ◽  
Cost Effective Alternative ◽  
Long Acting ◽  
The Cost

While the ACTH1–24 test has some well-documented shortcomings, it is the most widely used test to diagnose primary and secondary adrenal insufficiency. However, this synthetic ACTH preparation is not readily available in some countries. Research from India has demonstrated that using a long-acting porcine sequence ACTH has similar diagnostic performance to ACTH1–24 at around 25% of the cost. This may allow access to a robust test for adrenal insufficiency to developing countries and potentially allow thousands of patients to be identified and appropriately treated.

Development of Calibration Equipment for Geodetic Angle Measurement Instruments

2015 ◽  
Vol 220-221 ◽  
pp. 396-400
Author(s):  
Lauryna Šiaudinytė ◽  
Deividas Sabaitis ◽  
Domantas Bručas ◽  
Gintaras Dmitrijev
Keyword(s):  
Low Cost ◽  
Cost Effective ◽  
Angle Measurement ◽  
Measurement Instruments ◽  
Measurement Systems ◽  
Complex Processes ◽  
Cost Effective Alternative ◽  
Reducing Costs ◽  
The Cost

Production of high precision circular scales is a complicated process requiring expensive equipment and complex processes to achieve. Precision angle measurement equipment tends to be very expensive and therefore not accessible to all in need. Simplification of production of such devices can lead to reducing costs of angle measurement systems ensuring easier accessibility. A new method of producing precision circular scales using low cost mass production can reduce the costs of these devices drastically. Therefore, utilising a common CD technology as the basis for such scales is analysed. This paper deals with the analysis of the newest laser cutting method for plastic circular scales. Preliminary results of manufacturing such scales are presented in the paper as well as measurements of the grating of the scale were performed. The quality of different scales manufactured using different laser types is analysed in the study. The cost – effective alternative of manufacturing circular scales is discussed in the paper.

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