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

2018 ◽  
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.

scholarly journals Reassessing the Cost-Effectiveness of High-Provitamin A Bananas to Reduce Vitamin A Deficiency in Uganda

2021 ◽  
Vol 5 ◽  
Author(s):  
Marta Kozicka ◽  
Julia Elsey ◽  
Beatrice Ekesa ◽  
Susan Ajambo ◽  
Enoch Kikulwe ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Vitamin A Deficiency ◽  
Cost Effective ◽  
Provitamin A ◽  
Disability Adjusted Life ◽  
Alternative Scenarios ◽  
And Shifts ◽  
The Cost ◽  
Disability Adjusted Life Year ◽  
Promotion Campaigns

There are two high-provitamin A (pVA) banana-based interventions potentially available in Uganda—biofortified genetically modified (GM) banana and fast-tracked banana landraces from outside Uganda that are naturally high in provitamin A (nHpVA). Based on the newest country statistics and using adoption scenarios obtained through focus group discussions and expert interviews, we assess obstacles and opportunities for adoption as well as cost-effectiveness of these interventions. In two alternative scenarios for the GM banana (M9 matooke), we assume 40% and 64% adoption rates, which would result in US$29,374,151 and US$63,259,415 in income saved, respectively. As an alternative, for the symmetrical scenarios, we calculate that if the nHpVA banana (Apantu plantain, native of Ghana) were to be adopted, US$46,100,148 and US$76,364,988 in income would be saved. Taking into account the full cost of R&D, we estimate that the M9 matooke could save one disability-adjusted life year (DALY) at a cost of US$67.37 at best and US$145.09 at worst. We estimate that the Apantu plantain could save one DALY at a cost of US$50.54 at best and US$83.72 at worst. Our DALY analysis estimates that all assessed HpVA banana interventions are extremely cost-effective in all scenarios, following both the World Bank's and the WHO criteria. Nevertheless, successful interventions would require extensive promotion campaigns and shifts in agricultural value chains.

scholarly journals Cost-effective policy option in launching a community-based pneumococcal vaccination program among the elderly in Japan

2012 ◽  
Vol 3 (1) ◽  
pp. 8
Author(s):  
Shu-Ling Hoshi ◽  
Masahide Kondo ◽  
Ichiro Okubo
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Vaccine Development ◽  
Pneumococcal Vaccination ◽  
Cost Effective ◽  
The Elderly ◽  
Policy Option ◽  
Vaccination Program ◽  
Markov Modelling ◽  
Vaccination Programs

In Japan, some municipalities introduced a publicly funded pneumococcal vaccination program for the elderly. The expansion of such program has become one of the current topics in the health policy arena. We aim to appraise the value for money of expanding such programs, or starting one in a municipality without a program. We conducted a cost-effectiveness analysis with Markov modelling and calculated incremental cost-effectiveness ratio value of starting such a program with 36 different design options, 3 minimum age criteria for the entitlement to the subsidy and 12 levels of co-payment. We found that the introduction of vaccination programs costs more and gains more regardless of targeting ages and co-payment levels. Estimated incremental cost-effectiveness ratios range from ¥ 8,263,340 per year-of-life-saved (targeting age 65 or over, setting co-payment level at ¥ 0) to ¥ 10,351,324 per year-of-lifesaved (targeting age 75 or over, setting co-payment level at ¥ 5000). According to cost-effectiveness acceptability curves, the probability that a vaccination program is less than ¥ 10,000,000 (US $ 1 = ¥ 100) per life-year gained ranges from 28.5% to 57.5%. By adopting the threshold of the Committee to Study Priority for Vaccine Development in the US, US $ 100,000 per quality adjusted life year gain, all the programs are almost certainly judged cost-effective as vaccination strategies.

scholarly journals Disregarding the restrictive vial-opening policy for BCG vaccine in Guinea-Bissau: impact and cost-effectiveness for tuberculosis mortality and all-cause mortality in children aged 0–4 years

2021 ◽  
Vol 6 (8) ◽  
pp. e006127
Author(s):  
Sanne M Thysen ◽  
Ane Baerent Fisker ◽  
Stine Byberg ◽  
Peter Aaby ◽  
Partho Roy ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Low Income ◽  
Low Cost ◽  
Bcg Vaccine ◽  
Low Income Countries ◽  
Uncertainty Range ◽  
Policy Scenario ◽  
Guinea Bissau ◽  
All Cause Mortality

ObjectiveBCG vaccination is frequently delayed in low-income countries. Restrictive vial-opening policies, where a vial of BCG vaccine is not opened for few children, are a major reason for delay. During delays, children are unprotected against tuberculosis (TB) and deprived of non-specific effects of BCG. We assessed the potential effect and cost-effectiveness of disregarding the restrictive vial-opening policy, on TB and all-cause mortality, in children aged 0–4 years in Guinea-Bissau.MethodsUsing static mathematical models, we estimated the absolute and percentage change in TB and all-cause deaths, in children aged 0–4 years, between the current BCG vaccine restrictive-opening policy scenario, and a non-restrictive policy scenario where all children were vaccinated in the first health-facility contact. Incremental cost-effectiveness was estimated by integration of vaccine and treatment costs.FindingsDisregarding the restrictive BCG vial-opening policy was estimated to reduce TB deaths by 11.0% (95% uncertainty range (UR):0.5%–28.8%), corresponding to 4 (UR:0–15) TB deaths averted per birth cohort in Guinea-Bissau, resulting in incremental cost-effectiveness of US$ 911 per discounted life-year gained (LYG) (UR:145–9142). For all-cause deaths, the estimated reduction was 8.1% (UR: 3.3%–12.7%) corresponding to 392 (UR:158–624) fewer all-cause deaths and an incremental cost-effectiveness of US$ 9 (UR:5–23) per discounted LYG.ConclusionsDisregarding the restrictive BCG vial-opening policy was associated with reductions in TB deaths and all-cause deaths and low cost-effectiveness ratios. Our results suggest that it would be cost-effective to disregard the restrictive vial-opening policy. Other settings with similar practice are also likely to gain from disregarding this policy.

scholarly journals The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242170
Author(s):  
Stephanie Bogdewic ◽  
Rohit Ramaswamy ◽  
David M. Goodman ◽  
Emmanuel K. Srofenyoh ◽  
Sebnem Ucer ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Neonatal Mortality ◽  
Clinical Skills ◽  
Cost Effective ◽  
Regional Hospital ◽  
Sensitivity Analyses ◽  
Neonatal Deaths ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Disability Adjusted Life Year

Objective To evaluate the cost-effectiveness of a program intended to reduce intrapartum and neonatal mortality in Accra, Ghana. Design Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. Methods A program integrating leadership development, clinical skills and quality improvement training was piloted at the Greater Accra Regional Hospital from 2013 to 2016. The number of intrapartum and neonatal deaths prevented were estimated using the hospital’s 2012 stillbirth and neonatal mortality rates as a steady-state assumption. The cost-effectiveness of the intervention was calculated as cost per disability-adjusted life year (DALY) averted. In order to test the assumptions included in this analysis, it was subjected to probabilistic and one-way sensitivity analyses. Main outcome measures Incremental cost-effectiveness ratio (ICER), which measures the cost per disability-adjusted life-year averted by the intervention compared to status quo. Results From 2012 to 2016, there were 45,495 births at the Greater Accra Regional Hospital, of whom 5,734 were admitted to the newborn intensive care unit. The budget for the systems strengthening program was US $1,716,976. Based on program estimates, 307 (±82) neonatal deaths and 84 (±35) stillbirths were prevented, amounting to 12,342 DALYs averted. The systems strengthening intervention was found to be highly cost effective with an ICER of US $139 (±$44), an amount significantly lower than the established threshold of cost-effectiveness of the per capita gross domestic product, which averaged US $1,649 between 2012–2016. The results were found to be sensitive to the following parameters: DALYs averted, number of neonatal deaths, and number of stillbirths. Conclusion An integrated approach to system strengthening in referral hospitals has the potential to reduce neonatal and intrapartum mortality in low resource settings and is likely to be cost-effective. Sustained change can be achieved by building organizational capacity through leadership and clinical training.

scholarly journals Pneumococcal conjugate vaccination in The Gambia: health impact, cost effectiveness and budget implications

2021 ◽  
Vol 6 (12) ◽  
pp. e007211
Author(s):  
Clint Pecenka ◽  
Effua Usuf ◽  
Ilias Hossain ◽  
Sana Sambou ◽  
Elisabeth Vodicka ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Low Income ◽  
Pneumococcal Vaccination ◽  
The Gambia ◽  
Low Income Countries ◽  
Birth Cohorts ◽  
The Cost ◽  
Conjugate Vaccination ◽  
The Impact

IntroductionIntroducing pneumococcal conjugate vaccine (PCV) in many low-income countries has contributed to reductions in global childhood deaths caused by Streptococcus pneumoniae. Many low-income countries, however, will soon reach an economic status leading to transition from Gavi, the Vaccine Alliance vaccine funding support and then face increased expenditure to continue PCV programmes. Evaluating the cost-effectiveness of PCV in low-income countries will inform such country decisions.MethodsWe used empiric data on the costs of vaccine delivery and pneumococcal disease and PCV programme impact on disease among children less than 5 years old in The Gambia. We used the UNIVAC cost-effectiveness modelling tool to compare the impact and cost-effectiveness of pneumococcal conjugate vaccination to no vaccination over 20 birth cohorts starting in 2011. We calculated costs per disability-adjusted-life-year (DALY) averted from government and societal perspectives and undertook scenario and probabilistic sensitivity analysis.ResultsWe projected that, over 20 years, PCV in The Gambia could avert 117 000 total disease episodes in children less than 5 years old, including outpatient and hospitalised pneumonia, pneumococcal sepsis and meningitis (including sequelae). Vaccination could avert 9000 outpatient pneumonia visits, 88 000 hospitalisations and 3300 deaths due to pneumonia, meningitis and sepsis. Approximately 100 000 DALYs are expected to be averted. Averted visits and hospitalisations represent US$4 million in healthcare costs expected to be saved by the government and US$7.3 million if household costs are included. The cost of the vaccination programme is estimated at US$2 million. In the base scenario, most alternative scenarios and nearly 90% of the probabilistic scenarios, pneumococcal vaccination is cost saving in The Gambia.ConclusionPneumococcal conjugate vaccination is expected to generate substantial health gains and is likely to be cost saving in The Gambia. Policymakers in similar settings should be confident to maintain their PCV programmes.

Cost-Effectiveness of Cognitive–Behavioural Therapy and Drug Interventions for Major Depression

2005 ◽  
Vol 39 (8) ◽  
pp. 683-692 ◽  
Author(s):  
Theo Vos ◽  
Justine Corry ◽  
Michelle M. Haby ◽  
Rob Carter ◽  
Gavin Andrews
Keyword(s):  
Cost Effectiveness ◽  
Major Depression ◽  
Maintenance Treatment ◽  
Treatment Options ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Disability Adjusted Life Year

Objective: Antidepressant drugs and cognitive–behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness – Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression. Method: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods. Results: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below $A10 000 per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from $A17 000 to $A20 000 per DALY) but still well below $A50 000, which is considered the affordable threshold. Conclusions: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.

scholarly journals Hospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitals

2021 ◽  
Vol 15 (1) ◽  
pp. e0008977
Author(s):  
Lorren Alumasa ◽  
Lian F. Thomas ◽  
Fredrick Amanya ◽  
Samuel M. Njoroge ◽  
Ignacio Moriyón ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
National Level ◽  
Cost Effective ◽  
Human Brucellosis ◽  
Serum Samples ◽  
Therapy Regimen ◽  
Treatment Regimens ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Disability Adjusted Life Year

Hospitals in Kenya continue to use the Febrile Antigen Brucella Agglutination Test (FBAT) to diagnose brucellosis, despite reports showing its inadequacy. This study generated hospital-based evidence on the performance and cost-effectiveness of the FBAT, compared to the Rose Bengal Test (RBT).Twelve hospitals in western Kenya stored patient serum samples that were tested for brucellosis using the FBAT, and these were later re-tested using the RBT. Data on the running time and cost of the FBAT, and the treatment prescribed for brucellosis, were collected. The cost-effectiveness of the two tests, defined as the cost in US Dollars ($) per Disability Adjusted Life Year (DALY) averted, was determined, and a basic sensitivity analysis was run to identify the most influential parameters. Over a 6-month period, 180 patient serum samples that were tested with FBAT at the hospitals were later re-tested with RBT at the field laboratory. Of these 24 (13.3%) and 3 (1.7%) tested positive with FBAT and RBT, respectively. The agreement between the FBAT and RBT was slight (Kappa = 0.12). Treatment prescribed following FBAT positivity varied between hospitals, and only one hospital prescribed a standardized therapy regimen. The mean $/DALY averted when using the FBAT and RBT were $2,065 (95% CI $481-$6,736) and $304 (95% CI $126-$604), respectively. Brucellosis prevalence was the most influential parameter in the cost-effectiveness of both tests. Extrapolation to the national level suggested that an estimated $338,891 (95% CI $47,000-$1,149,000) per year is currently spent unnecessarily treating those falsely testing positive by FBAT. These findings highlight the potential for misdiagnosis using the FBAT. Furthermore, the RBT is cost-effective, and could be considered as the mainstay screening test for human brucellosis in this setting. Lastly, the treatment regimens must be harmonized to ensure the appropriate use of antibiotics for treatment.

scholarly journals Impact and cost-effectiveness of snail control to achieve disease control targets for schistosomiasis

2018 ◽  
Vol 115 (4) ◽  
pp. E584-E591 ◽  
Author(s):  
Nathan C. Lo ◽  
David Gurarie ◽  
Nara Yoon ◽  
Jean T. Coulibaly ◽  
Eran Bendavid ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Disease Control ◽  
Control Strategies ◽  
Cost Effective ◽  
Snail Host ◽  
Snail Control ◽  
Disability Adjusted Life ◽  
Life Years ◽  
High Prevalence

Schistosomiasis is a parasitic disease that affects over 240 million people globally. To improve population-level disease control, there is growing interest in adding chemical-based snail control interventions to interrupt the lifecycle of Schistosoma in its snail host to reduce parasite transmission. However, this approach is not widely implemented, and given environmental concerns, the optimal conditions for when snail control is appropriate are unclear. We assessed the potential impact and cost-effectiveness of various snail control strategies. We extended previously published dynamic, age-structured transmission and cost-effectiveness models to simulate mass drug administration (MDA) and focal snail control interventions against Schistosoma haematobium across a range of low-prevalence (5–20%) and high-prevalence (25–50%) rural Kenyan communities. We simulated strategies over a 10-year period of MDA targeting school children or entire communities, snail control, and combined strategies. We measured incremental cost-effectiveness in 2016 US dollars per disability-adjusted life year and defined a strategy as optimally cost-effective when maximizing health gains (averted disability-adjusted life years) with an incremental cost-effectiveness below a Kenya-specific economic threshold. In both low- and high-prevalence settings, community-wide MDA with additional snail control reduced total disability by an additional 40% compared with school-based MDA alone. The optimally cost-effective scenario included the addition of snail control to MDA in over 95% of simulations. These results support inclusion of snail control in global guidelines and national schistosomiasis control strategies for optimal disease control, especially in settings with high prevalence, “hot spots” of transmission, and noncompliance to MDA.

scholarly journals COVID-19 Vaccines Cost-Effectiveness Analysis: A Scenario for Iran

Vaccines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 37
Author(s):  
Atefeh Vaezi ◽  
Alipasha Meysamie
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effectiveness Analysis ◽  
Incremental Cost Effectiveness Ratio ◽  
Decision Making Process ◽  
Cost Effectiveness Ratio ◽  
Effectiveness Analysis ◽  
Critical Measure ◽  
Disability Adjusted Life ◽  
Disability Adjusted Life Year

COVID-19 vaccines are supposed to be critical measure for ending the pandemic. Governments had to decide on the type of vaccine to provide for their population. In this decision-making process, cost-effectiveness analysis is considered a helpful tool. This study is a cost-effectiveness analysis utilized to calculate the incremental cost per averted disability-adjusted life year (DALY) by vaccination compared to no vaccination for different COVID-19 vaccines. The incremental cost-effectiveness ratio (ICER) for a vaccination with COVID-19 vaccines was estimated at 6.2 to 121.2 USD to avert one DALY and 566.8 to 10,957.7 USD per one death. The lowest and highest ICERs belong to Ad26.COV2.S and CoronaVac, respectively. Considering the scenario of Iran, vaccines that are recommended include ad26.cov2.s, chadox1-S, rAd26-S + rAd5-S, and BNT162b2 in the order of recommendation.

scholarly journals Impact and cost-effectiveness of potential interventions against infant respiratory syncytial virus (RSV) in 131 low-income and middle-income countries using a static cohort model

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e046563
Author(s):  
Ranju Baral ◽  
Deborah Higgins ◽  
Katie Regan ◽  
Clint Pecenka
Keyword(s):  
Respiratory Syncytial Virus ◽  
Cost Effectiveness ◽  
Low Income ◽  
Cost Effective ◽  
Cohort Model ◽  
Middle Income ◽  
Middle Income Countries ◽  
Disability Adjusted Life ◽  
Syncytial Virus ◽  
Duration Of Protection

ObjectivesInterventions to prevent childhood respiratory syncytial virus (RSV) disease are limited and costly. New interventions are in advanced stages of development and could be available soon. This study aims to evaluate the potential impact and cost-effectiveness of two interventions to prevent childhood RSV—a maternal vaccine and a monoclonal antibody (mAb).DesignUsing a static population-based cohort model, we evaluate impact and cost-effectiveness of RSV interventions, from a health systems perspective. The assumed baseline efficacy and duration of protection were higher for the mAb (60%–70% efficacy, protection 6 months) compared with the maternal vaccine (40%–60% efficacy, protection 3 months). Both interventions were evaluated at US$3 and US$5 per dose for Gavi and non-Gavi countries, respectively. A range of input values were considered to explore uncertainty.Settings131 low-income and middle-income countries.ParticipantsPregnant women and live birth cohorts.InterventionsMaternal vaccine given to pregnant women and mAb given to young infants.Primary and secondary outcome measuresDisability-adjusted life years averted, severe case averted, deaths averted, incremental cost effectiveness ratios.ResultsUnder baseline assumptions, maternal vaccine and mAbs were projected to avert 25% and 55% of RSV-related deaths among infants younger than 6 months of age, respectively. The average incremental cost-effectiveness ratio per disability-adjusted life year averted was US$1342 (range US$800–US$1866) for maternal RSV vaccine and US$431 (range US$167–US$692) for mAbs. At a 50% gross domestic product per capita threshold, maternal vaccine and mAbs were cost-effective in 60 and 118 countries, respectively.ConclusionsBoth interventions are projected to be impactful and cost-effective in many countries, a finding that would be enhanced if country-specific Gavi cofinancing to eligible countries were included. mAbs, with assumed higher efficacy and duration of protection, are expected to be more cost-effective than RSV maternal vaccines at similar prices. Final product characteristics will influence this finding.

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