Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

Low- and middle-income countries are implementing COVID-19 vaccination strategies in light of varying and uncertain vaccine efficacies and costs, supply shortages, and resource constraints. We used a microsimulation model to evaluate clinical outcomes and cost-effectiveness of a COVID-19 vaccination program in South Africa. We varied vaccination coverage, pace, acceptance, effectiveness, and cost as well as epidemic dynamics. Providing vaccine to at least 40% of the population and prioritizing accelerated vaccine rollout prevented >9 million infections and >73,000 deaths and reduced costs due to fewer hospitalizations. Further, the vaccination program was cost-saving even at the lowest examined levels of acceptance (50%), effectiveness against infection (20%), effectiveness against symptomatic disease (30%), and effectiveness against severe/critical disease requiring hospitalization (40%), and with vaccination costs of up to USD25/person. In summary, a COVID-19 vaccination program would reduce both deaths and health care costs in South Africa across a wide range of assumptions. Vaccination program implementation factors, including prompt procurement, distribution, and rollout, are likely more influential than characteristics of the vaccine itself in maximizing public health benefits and economic efficiency.

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Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

Nature Communications ◽

10.1038/s41467-021-26557-5 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Krishna P. Reddy ◽

Kieran P. Fitzmaurice ◽

Justine A. Scott ◽

Guy Harling ◽

Richard J. Lessells ◽

...

Keyword(s):

South Africa ◽

Cost Effectiveness ◽

Clinical Outcomes ◽

Program Implementation ◽

Resource Constraints ◽

Vaccination Program ◽

Middle Income ◽

Epidemic Dynamics ◽

Middle Income Countries ◽

Wide Range

AbstractLow- and middle-income countries are implementing COVID-19 vaccination strategies in light of varying vaccine efficacies and costs, supply shortages, and resource constraints. Here, we use a microsimulation model to evaluate clinical outcomes and cost-effectiveness of a COVID-19 vaccination program in South Africa. We varied vaccination coverage, pace, acceptance, effectiveness, and cost as well as epidemic dynamics. Providing vaccines to at least 40% of the population and prioritizing vaccine rollout prevented >9 million infections and >73,000 deaths and reduced costs due to fewer hospitalizations. Model results were most sensitive to assumptions about epidemic growth and prevalence of prior immunity to SARS-CoV-2, though the vaccination program still provided high value and decreased both deaths and health care costs across a wide range of assumptions. Vaccination program implementation factors, including prompt procurement, distribution, and rollout, are likely more influential than characteristics of the vaccine itself in maximizing public health benefits and economic efficiency.

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Spiritual care practices in hospices in the Western cape, South Africa: the challenge of diversity

BMC Palliative Care ◽

10.1186/s12904-020-00704-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Ronita Mahilall ◽

Leslie Swartz

Keyword(s):

South Africa ◽

Spiritual Care ◽

Resource Constraints ◽

Care Service ◽

Western Cape ◽

Group Discussions ◽

Middle Income ◽

Care Services ◽

African Context ◽

Care Practices

Abstract Background South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust. Discussion Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.

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The cost-effectiveness of hypertension management in low-income and middle-income countries: a review

BMJ Global Health ◽

10.1136/bmjgh-2019-002213 ◽

2020 ◽

Vol 5 (9) ◽

pp. e002213

Author(s):

Deliana Kostova ◽

Garrison Spencer ◽

Andrew E Moran ◽

Laura K Cobb ◽

Muhammad Jami Husain ◽

...

Keyword(s):

Cost Effectiveness ◽

Low Income ◽

Disease Risk ◽

National Income ◽

Economic Evaluations ◽

Health Improvement ◽

Middle Income ◽

Middle Income Countries ◽

Wide Range ◽

The Cost

Hypertension in low-income and middle-income countries (LMICs) is largely undiagnosed and uncontrolled, representing an untapped opportunity for public health improvement. Implementation of hypertension control strategies in low-resource settings depends in large part on cost considerations. However, evidence on the cost-effectiveness of hypertension interventions in LMICs is varied across geographical, clinical and evaluation contexts. We conducted a comprehensive search for published economic evaluations of hypertension treatment programmes in LMICs. The search identified 71 articles assessing a wide range of hypertension intervention designs and cost components, of which 42 studies across 15 countries reported estimates of cost-effectiveness. Although comparability of results was limited due to heterogeneity in the interventions assessed, populations studied, costs and study quality score, most interventions that reported cost per averted disability-adjusted life-year (DALY) were cost-effective, with costs per averted DALY not exceeding national income thresholds. Programme elements that may reduce cost-effectiveness included screening for hypertension at younger ages, addressing prehypertension, or treating patients at lower cardiovascular disease risk. Cost-effectiveness analysis could provide the evidence base to guide the initiation and development of hypertension programmes.

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Spiritual care practices in hospices in the Western Cape, South Africa: The challenge of diversity

10.21203/rs.3.rs-60549/v2 ◽

2020 ◽

Author(s):

Ronita Mahilall ◽

Leslie Swartz

Keyword(s):

South Africa ◽

Spiritual Care ◽

Resource Constraints ◽

Care Service ◽

Western Cape ◽

Group Discussions ◽

Middle Income ◽

Care Services ◽

African Context ◽

Care Practices

Abstract Background: South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods: Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results:Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust.Discussion:Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions:While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.

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Cost and cost-effectiveness of a parenting programme to prevent violence against adolescents in South Africa

BMJ Global Health ◽

10.1136/bmjgh-2018-001147 ◽

2019 ◽

Vol 4 (3) ◽

pp. e001147 ◽

Cited By ~ 1

Author(s):

Alice Redfern ◽

Lucie D Cluver ◽

Marisa Casale ◽

Janina I Steinert

Keyword(s):

South Africa ◽

Cost Effectiveness ◽

Low Income ◽

Emotional Abuse ◽

Controlled Trial ◽

Cost Effective ◽

Cluster Randomised Controlled Trial ◽

Economic Benefits ◽

Parenting Programme ◽

Middle Income

IntroductionThis paper presents the costs and cost-effectiveness of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a non-commercialised parenting programme aimed at preventing violence against adolescents in low-income and middle-income countries.MethodsThe effectiveness of Sinovuyo Teen was evaluated with a cluster randomised controlled trial in 40 villages and peri-urban townships in the Eastern Cape of South Africa from 2015 to 2016. The costs of implementation were calculated retrospectively and models of costs at scale estimated, from the perspective of the programme provider. Cost-effectiveness analysis considers both the cost per incident of abuse averted, and cost per disability-adjusted life year averted. Potential economic benefits from the societal perspective were estimated by developing a framework of possible savings.ResultsThe total implementation cost for Sinovuyo Teen over the duration of the trial was US$135 954, or US$504 per family enrolled. Among the 270 families in the treatment group, an estimated 73 incidents of physical and emotional abuse were averted (95% CI 29 to 118 incidents averted). During the trial, the total cost per incident of physical or emotional abuse averted was US$1837, which is likely to decrease to approximately US$972 if implemented at scale. By comparison, the economic benefits of averting abuse in South Africa are large with an estimated lifetime saving of US$2724 minimum per case.ConclusionParenting programmes are a cost-effective intervention to prevent the abuse of adolescents by their caregivers in South Africa, when compared with existing violence prevention programmes and cost-effectiveness thresholds based on GDP per capita.

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Cost-Utility of Sildenafil for Persistent Pulmonary Hypertension of the Newborn

American Journal of Perinatology ◽

10.1055/s-0040-1713819 ◽

2020 ◽

Author(s):

Patrick D. Evers ◽

Paul J. Critser ◽

Michelle Cash ◽

Melissa Magness ◽

Susan Hoelle ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Cost Effectiveness ◽

Relative Risk ◽

Cost Effective ◽

Cost Utility ◽

Persistent Pulmonary Hypertension ◽

Middle Income ◽

Middle Income Countries ◽

Wide Range ◽

The Impact

Objective While advanced therapies for severe persistent pulmonary hypertension of the newborn (PPHN) such as inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation (ECMO) are standard treatments in high-income countries, these therapies are often unavailable in resource-limited settings such as middle-income countries. However, there are small clinical trials illustrating the efficacy of sildenafil at reducing mortality in PPHN. This analysis sought to determine the cost-utility of enteral sildenafil for the treatment of severe PPHN. Study Design A Markov-state transition model was constructed for the two clinical approaches to compare costs, clinical outcomes, and quality of life: (1) “conventional,” (2) “sildenafil.” The impact of sildenafil was modeled as a relative risk modifier of the conventional strategy's mortality risk. Transitional probabilities, costs, and utility metrics were extracted from the literature. Sensitivity analyses for each model input as well as 100-patient Monte Carlo simulations were used to test the durability of the model conclusion. Results The sildenafil strategy was cost-effective for upper but not lower middle-income countries with an incremental cost-effectiveness ratio of $2,339 per quality-adjusted life year. This conclusion was durable across a wide-range of model assumptions; the sildenafil strategy only failed to meet criteria for cost-effectiveness when sildenafil therapy had a mortality relative risk efficacy of >0.89, if life expectancy in that country is <40 years, or if the lifetime forecasted costs of a survivor's life was quite high. Conclusion Enteral sildenafil is a cost-effective intervention for severe PPHN for upper middle-income countries where ECMO and iNO are not available. Key Points

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Cost-effectiveness of public health strategies for COVID-19 epidemic control in South Africa

10.1101/2020.06.29.20140111 ◽

2020 ◽

Cited By ~ 1

Author(s):

Krishna P. Reddy ◽

Fatma M. Shebl ◽

Julia H. A. Foote ◽

Guy Harling ◽

Justine A. Scott ◽

...

Keyword(s):

Public Health ◽

South Africa ◽

Cost Effectiveness ◽

Resource Constraints ◽

Control Strategies ◽

Diagnostic Testing ◽

Cost Effective ◽

Contact Tracing ◽

Epidemic Control ◽

Symptom Screening

ABSTRACTBackgroundHealthcare resource constraints in low and middle-income countries necessitate selection of cost-effective public health interventions to address COVID-19.MethodsWe developed a dynamic COVID-19 microsimulation model to evaluate clinical and economic outcomes and cost-effectiveness of epidemic control strategies in KwaZulu-Natal, South Africa. Interventions assessed were Healthcare Testing (HT), where diagnostic testing is performed only for those presenting to healthcare centres; Contact Tracing (CT) in households of cases; Isolation Centres (IC), for cases not requiring hospitalisation; community health worker-led Mass Symptom Screening and diagnostic testing for symptomatic individuals (MS); and Quarantine Centres (QC), for contacts who test negative. Given uncertainties about epidemic dynamics in South Africa, we evaluated two main epidemic scenarios over 360 days, with effective reproduction numbers (Re) of 1·5 and 1·2. We compared HT, HT+CT, HT+CT+IC, HT+CT+IC+MS, HT+CT+IC+QC, and HT+CT+IC+MS+QC, considering strategies with incremental cost-effectiveness ratio (ICER) <US$1,290/year-of-life saved (YLS) to be cost-effective.FindingsWith Re 1·5, HT resulted in the most COVID-19 deaths and lowest costs over 360 days. Compared with HT, HT+CT+IC+MS reduced mortality by 76%, increased costs by 16%, and was cost-effective (ICER $350/YLS). HT+CT+IC+MS+QC provided the greatest reduction in mortality, but increased costs by 95% compared with HT+CT+IC+MS and was not cost-effective (ICER $8,000/YLS). With Re 1·2, HT+CT+IC+MS was the least costly strategy, and HT+CT+IC+MS+QC was not cost-effective (ICER $294,320/YLS).InterpretationIn South Africa, a strategy of household contact tracing, isolation, and mass symptom screening would substantially reduce COVID-19 mortality and be cost-effective. Adding quarantine centres for COVID-19 contacts is not cost-effective.FundingRoyal Society, Wellcome Trust, National Institutes of Health

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How local context influences access to neuropsychological rehabilitation after acquired brain injury in South Africa

BMJ Global Health ◽

10.1136/bmjgh-2018-001353 ◽

2019 ◽

Vol 4 (Suppl 10) ◽

pp. e001353

Author(s):

Noorjehan Joosub

Keyword(s):

South Africa ◽

Brain Injury ◽

Low Income ◽

Resource Constraints ◽

Acquired Brain Injury ◽

Local Context ◽

Contextual Influences ◽

Healthcare Resources ◽

Middle Income ◽

Neuropsychological Rehabilitation

The numbers of acquired brain injury (ABI) survivors in South Africa are increasing; however, facilities to provide neuropsychological rehabilitation are limited due to a lack of healthcare resources. The updated International Classification of Health, Functioning, and Disability (ICF) from the WHO emphasises how the context of an impairment influences the patient’s activity limitations and participation restrictions. This analysis examined South African contextual influences on the accessibility, quality and efficiency of neuropsychological rehabilitation interventions after ABI in South Africa. Three main contextual influences were identified, namely, socioeconomic disparities, sociocultural influences and discharge to underprepared communities. Systems thinking and inclusive models of healthcare are needed in low-income and middle-income countries, such as South Africa, where resource constraints necessitate creative and ecological forms of rehabilitation interventions after ABI. Contextual influences are vital to consider when designing neuropsychological rehabilitation interventions in order to improve the accessibility and relevance of these interventions and to ensure the effective utilisation of scarce healthcare resources.

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Spiritual Care Practices in Hospices in the Western Cape, South Africa: The Challenge of Diversity

10.21203/rs.3.rs-60549/v1 ◽

2020 ◽

Author(s):

Ronita Mahilall ◽

Leslie Swartz

Keyword(s):

South Africa ◽

Spiritual Care ◽

Resource Constraints ◽

Care Service ◽

Western Cape ◽

Group Discussions ◽

Middle Income ◽

Care Services ◽

African Context ◽

Care Practices

Abstract Background: South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods: Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices were at play in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results:Two prominent themes emerged: providing relevant spiritual care services in a religiously, culturally, and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial shortfalls. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust.Discussion:Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions:While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.

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The effect of COVID-19 on maternal newborn and child health (MNCH) services in Bangladesh, Nigeria and South Africa: call for a contextualised pandemic response in LMICs

International Journal for Equity in Health ◽

10.1186/s12939-021-01414-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Tanvir Ahmed ◽

Ahmed Ehsanur Rahman ◽

Taiwo Gboluwaga Amole ◽

Hadiza Galadanci ◽

Mushi Matjila ◽

...

Keyword(s):

South Africa ◽

Resource Constraints ◽

Childhood Mortality ◽

Health Priorities ◽

Local Context ◽

Middle Income ◽

Mortality And Morbidity ◽

Middle Income Countries ◽

Care Family ◽

Development Goals

AbstractGlobal response to COVID-19 pandemic has inadvertently undermined the achievement of existing public health priorities and laregely overlooked local context. Recent evidence suggests that this will cause additional maternal and childhood mortality and morbidity especially in low- and middle-income countries (LMICs). Here we have explored the contextual factors influencing maternal, neonatal and children health (MNCH) care in Bangladesh, Nigeria and South Africa amidst the pandemic. Our findings suggest that between March and May 2020, there was a reduction in utilisation of basic essential MNCH services such as antenatal care, family planning and immunization due to: a) the implementation of lockdown which triggered fear of contracting the COVID-19 and deterred people from accessing basic MNCH care, and b) a shift of focus towards pandemic, causing the detriment to other health services, and c) resource constraints. Taken together these issues have resulted in compromised provision of basic general healthcare. Given the likelihood of recurrent waves of the pandemic globally, COVID-19 mitigation plans therefore should be integrated with standard care provision to enhance system resilience to cope with all health needs. This commentary suggests a four-point contextualised mitigation plan to safeguard MNCH care during the pandemic using the observed countries as exemplars for LMIC health system adaptations to maintain the trajectory of progress regarding sustainable development goals (SDGs).

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