scholarly journals Country contextualisation of cost-effectiveness studies: lessons from Ethiopia

2019 ◽  
Vol 4 (6) ◽  
pp. e001320 ◽  
Author(s):  
Kjell Arne Johansson ◽  
Mieraf Taddesse Tolla ◽  
Solomon Tessema Memirie ◽  
Ingrid Miljeteig ◽  
Mahlet Kifle Habtemariam ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Priority Setting ◽  
Health Benefits ◽  
Neonatal Resuscitation ◽  
Low Income Countries ◽  
Health Coverage ◽  
Policy Makers ◽  
Life Years ◽  
Per Capita

Emerging demographic, epidemiological and health system changes in low-income countries require revisions of national essential health services packages in accordance with standard healthcare priority setting methods. Policy makers are in need of explicit and user-friendly methods to compare impact of multiple interventions. We provide experiences of country contextualisation of WHO-CHOICE methods and models to a country level. Results from three contextualised cost-effectiveness analyses (CEAs) are presented, and we discuss how this evidence can inform priority setting in Ethiopia. Existing models for a range of interventions in obstetric and neonatal care, psychiatric and neurological treatment and prevention and treatment of cardiovascular diseases are contextualised to the Ethiopian setting. CEAs are defined as contextualised if they include national analysts and use country-specific input for either costs, epidemiology, demography, baseline coverage or effects. Interventions (n=61) are ranked according to incremental cost-effectiveness rates (ICERs), and expected health outcomes (Disability Adjusted Life Years (DALYs) averted) and budget impacts are presented for each intervention. Dominated interventions (n=30) were excluded. A US$2.8 increase per capita in the annual health budget is needed in Ethiopia (currently at US$28 per capita) for increasing coverage by 20%–75% for all the 22 interventions with positive net health benefits. This investment is expected to give a net benefit at around 0.5 million DALYs averted in return in total, with a willingness to pay threshold at US$2000 per DALY averted. In particular, three interventions, neonatal resuscitation, kangaroo mother care and antibiotics for newborn sepsis, stand out as best buys in an Ethiopian setting. Our method of contextualised CEAs provides important information for policy makers. Rank ordering of interventions by ICERs, together with presentations of expected budget impact and net health benefits, is a clear and policy friendly illustration of possible efficient stepwise pathways towards universal health coverage.

scholarly journals Concomitant health benefits package design and research prioritisation: development of a new approach and an application to Malawi

2021 ◽  
Vol 6 (12) ◽  
pp. e007047
Author(s):  
Laetitia Schmitt ◽  
Jessica Ochalek ◽  
Karl Claxton ◽  
Paul Revill ◽  
Dominic Nkhoma ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Benefits ◽  
Health Sector ◽  
Research Priorities ◽  
Evidence Base ◽  
Preventive Therapy ◽  
Acute Malnutrition ◽  
Health Coverage ◽  
Life Years ◽  
Research Prioritisation

Health benefits packages (HBPs) are increasingly used in many countries to guide spending priorities on the path towards universal health coverage. Their design is, however, informed by an uncertain evidence base but research funds available to address this are limited. This gives rise to the question of which piece of research relating to the cost-effectiveness of interventions would most contribute to improving resource allocation. We propose to incorporate research prioritisation as an integral part of HBP design. We have, therefore, developed a framework and a freely available companion stand-alone tool, to quantify in terms of net disability-adjusted life-years (DALYs) averted, the value of research for the interventions considered for inclusion in a package. Using the tool, the framework can be implemented using sensitivity analysis results typically reported in cost-effectiveness studies. To illustrate the framework, we applied the tool to the evidence base that informed the Malawi Health Sector Strategic Plan 2017–2022. Out of 21 interventions considered, 8 investment decisions were found to be uncertain and three showed strong potential for research to generate large health gains: ‘male circumcision’, ‘community-management of acute malnutrition in children’ and ‘isoniazid preventive therapy in HIV +individuals’, with a potential to avert up to 65 762, 36 438 and 20 132 net DALYs, respectively. Our work can help set research priorities in resource-constrained settings so that research funds are invested where they have the largest potential to impact on the population health generated via HBPs.

Evaluating the Outcomes of a Hospital-to-Community Model of Integrated Care for Dementia

2020 ◽  
pp. 1-6
Author(s):  
Ngoc Huong Lien Ha ◽  
Philip Yap Lin Kiat ◽  
Sean Olivia Nicholas ◽  
Ivana Chan ◽  
Shiou Liang Wee
Keyword(s):  
Cost Effectiveness ◽  
Integrated Care ◽  
Dementia Care ◽  
Behavioural Problems ◽  
Gdp Per Capita ◽  
Post Intervention ◽  
Cross Sectional ◽  
Life Years ◽  
Per Capita ◽  
The Cost

<b><i>Introduction:</i></b> Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of person-centred care, has been shown to maintain quality of life (QOL) in PWDs and caregivers, a lack of service integration can hinder effectiveness. <b><i>Methods:</i></b> CARITAS, an integrated care initiative provided through a hospital-community care partnership, endeavours to provide person-centred dementia care through ambulatory clinic consults, case management, patient and caregiver engagement, and support. We evaluated CARITAS’ clinical outcomes and cost-effectiveness with a naturalistic cross-sectional within-subject design. We assessed patients’ function, QOL, and behavioural problems post-intervention. We estimated CARITAS’ cost-effectiveness from a patient’s perspective, benchmarking it against other dementia treatments and Singapore’s Gross Domestic Product (GDP) per capita. <b><i>Results:</i></b> CARITAS care significantly improved health utility (<i>p</i> &#x3c; 0.001), reduced caregiver burden (<i>p</i> &#x3c; 0.001), and improved PWDs’ behavioural problems (<i>p</i> &#x3c; 0.001) related to “memory” (<i>p</i> &#x3c; 0.001), “disruption” (<i>p</i> = 0.017), and “depression” (<i>p</i> &#x3c; 0.001). CARITAS’ benefits (<i>d</i><sub>RMBPC</sub> = 0.357, <i>d</i><sub>EQ5D index</sub> = 0.328, <i>d</i><sub>ZBI</sub> = 0.361) were comparable to those of other pharmacological and non-pharmacological interventions for dementia. CARITAS costs SG$133,056.69 per quality-adjusted life years gain, yielding an incremental cost-effectiveness ratio of 1.31 and 1.49 against the cost of donepezil in patients with mild Alz­heimer’s disease and Singapore’s GDP per capita in 2019, respectively, falling within the cost-effectiveness threshold of 1.0–3.0. <b><i>Discussion:</i></b> CARITAS integrated dementia care is a cost-effective intervention that showed promising outcomes for PWDs and their caregivers.

scholarly journals Assessment of the Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries

2015 ◽  
Vol 212 (4) ◽  
pp. 570-577 ◽  
Author(s):  
Valentina Cambiano ◽  
Deborah Ford ◽  
Travor Mabugu ◽  
Sue Napierala Mavedzenge ◽  
Alec Miners ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Low Income Countries ◽  
Self Testing ◽  
Potential Impact

Infrastructure deficit and opportunities in Africa

2017 ◽  
Author(s):  
Albert Mafusire ◽  
Zuzana Brixiova ◽  
John Anyanwu ◽  
Qingwei Meng
Keyword(s):  
Private Sector ◽  
Low Income ◽  
Private Investment ◽  
Low Income Countries ◽  
Infrastructure Development ◽  
African Countries ◽  
Policy Makers ◽  
Private Sector Investment ◽  
Investment Opportunities ◽  
Financing Infrastructure

Private sector investment opportunities in Africa’s infrastructure are huge. Regulatory reforms across African countries are identified as critical to the realization of the expected investment flows in the infrastructure sector. However, planners and policy makers need to note that there are infrastructure deficiencies in all subsectors with low income countries (LICs) in Africa facing the greatest challenge. Inefficiencies in implementing infrastructure projects account for USD 17 billion annually and improving the capacity of African countries will help minimize these costs. In this regard, the donor community must play a greater role in African LICs while innovative financing mechanisms must be the focus in the relatively richer countries of the continent. Traditional sources of financing infrastructure development remain important but private investment is critical in closing the current gaps. Countries need to devise mechanisms to exploit opportunities and avoid pitfalls in investing in infrastructure.

scholarly journals Pooled Sputum for Xpert MTB/RIF Testing: A Cost Effectiveness Diagnostic Tool in Mwanza, Tanzania

2021 ◽  
Author(s):  
Shimba Henerico ◽  
Richard V. Makapa ◽  
Bernard C. Okamo ◽  
Benson R. Kidenya ◽  
Geoffrey Japhet ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Public Health Problem ◽  
Positive Sample ◽  
Low Income Countries ◽  
Global Public Health ◽  
Testing Strategy ◽  
Pooled Testing ◽  
The Individual ◽  
Pooled Samples

Abstract Background: Tuberculosis (TB) is a global public health problem, with the highest burden occurring in low-income countries, wherein the use of more sensitive diagnostics, such as Xpert MTB/RIF (GeneXpert), is still limited by costs. Testing of pooled samples from various individuals has been thought and thus investigated as a cost saving strategy to diagnose some diseases including TB. Then in cases where a pool is positive, retesting of the individual samples in that pool is done to identify the positive sample. We assessed the utility of a pooled testing strategy to optimize the affordability of GeneXpert for the diagnosis of TB Mwanza Tanzania. Methods: Remainder of samples from presumptive TB patients submitted for routine TB diagnosis were used for pooled samples (5 per pool) testing. The agreement of the results between individual sample testing against pooled samples testing and cost-effectiveness were assessed.Results: A total of 250 individual routinely submitted samples for TB diagnosis were tested using the established protocols. The median age of study participants was 35 [IQR 27 – 40] years and 143 (57.2%) were males. Of the 250 samples, 28 (11.2%) were detected to have MTB whereas 222 (88.8%) samples, were negative. Of the 50 sputum pools made, MTB were detected in 17 (34.0%) pools. Following retesting of these 17 positive pools, all 28 (100%) individual MTB samples were detected with the overall agreement being 100% (With the sensitivity of 100% and specificity of 100%). The number of individual MTB positive ranged from 1 to 3 per pool. Using pooling of sputum samples, the technique saved 115 (46.0%) of the cartridges in running 250 samples. This is equivalent to saving US$ 1147.7. Conclusion: The pooled sputum testing strategy reduced cartridge costs by 46.0%. The use of the pooled testing strategy reduces costs and has the potential to increase the affordability of GeneXpert testing in countries with limited resources. Pooled sputum for Xpert MTB/RIF can be used as an affordable diagnostic and/or screening tool in resource limited settings, such as Tanzania.

scholarly journals The Short Run Effects of Health Aid in Low Income Countries:Evidence from Panel Data Analysis

2019 ◽  
Author(s):  
Keneni Gutema Negeri
Keyword(s):  
Health Status ◽  
Panel Data ◽  
Low Income ◽  
Panel Data Analysis ◽  
Health Sector ◽  
Infant Mortality Rate ◽  
Low Income Countries ◽  
Health Coverage ◽  
Health Aid ◽  
Short Run

Abstract Background The effect of health targeted aid in developing countries is debatable. This paper examines the short run effect of health aid on health status in low income countries of the world. Method The study estimates the short run effect of health aid on health status in low income countries. Infant mortality rate was used as a proxy for health status and a panel data was constructed from 34 countries for the period between 2000 and 2017. For the estimation, first difference GMM and System GMM were employed. Results The estimation results confirm the argument that health aid has a beneficial and statistically significant short run effect on the health status of low income countries: doubling health aid saves the lives of 20 infants per 10,000 live births. Conclusion From the findings of this paper it can be concluded that health aid could be one of the best tools with which the broader health status gap currently observed between high income and low income groups, could be eliminated and hence the target of Universal Health Coverage is met. However, recipient countries need to find ways of promoting domestic factors that have favorable impact on health sector as they cannot persistently relay up on external resources.

Injury prevention and control

2021 ◽  
pp. 361-376
Author(s):  
Corinne Peek-Asa ◽  
Adnan A. Hyder
Keyword(s):  
Injury Prevention ◽  
Low Income ◽  
Prevention And Control ◽  
Low Income Countries ◽  
Middle Income ◽  
Injury Rates ◽  
Middle Income Countries ◽  
Disability Adjusted Life ◽  
Life Years ◽  
And Control

Injuries are among the leading causes of death and disability throughout the world and contribute disproportionately to premature life lost. Injury rates are highest among middle- and low-income countries. According to analyses of the 2016 Global Burden of Disease data, injuries cause over 4.6 million deaths per year, accounting for nearly 8.4% of all deaths and 10.7% of disability-adjusted life years. Many opportunities to implement injury prevention strategies exist, and a systematic approach to injury prevention can help identify the most effective and efficient approaches. Building capacity for injury prevention activities in low- and middle-income countries is an important public health priority.

Introduction: Resilience and sustainability

1998 ◽  
Vol 3 (2) ◽  
pp. 221-262 ◽  
Author(s):  
Charles Perrings
Keyword(s):  
Environmental Degradation ◽  
Low Income ◽  
Low Income Countries ◽  
Poverty Traps ◽  
Economic Systems ◽  
Social Scientists ◽  
Policy Makers ◽  
Ecological Concept ◽  
Ecological Economic ◽  
Lock In

One of the most interesting and potentially useful outcomes of recent collaboration between natural and social scientists concerned with the sustainability of jointly determined ecological-economic systems is the application of the ecological concept of resilience. In its broadest sense, resilience is a measure of the ability of a system to withstand stresses and shocks – its ability to persist in an uncertain world. For many policy-makers, however, the concern that desirable states or processes may not be ‘sustainable’ is balanced by the concern that individuals and societies may get ‘locked-in’ to undesirable states or processes. Many low-income countries, for example, are thought to have been caught in poverty traps, and poverty traps have since been seen as a major cause of environmental degradation (Dasgupta, 1993). Other examples of ‘lock-in’ include our dependence on hydrocarbon-based technologies, or the institutional and cultural rigidities that stand in the way of change (Hanna, Folke, and Mäler, 1996). Such states or processes are too persistent.

scholarly journals Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): will we meet the needs?

2019 ◽  
Vol 104 (4) ◽  
pp. 588-592 ◽  
Author(s):  
Serge Resnikoff ◽  
Van Charles Lansingh ◽  
Lindsey Washburn ◽  
William Felch ◽  
Tina-Marie Gauthier ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Visual Impairment ◽  
Low Income ◽  
Care Delivery ◽  
Low Income Countries ◽  
Gdp Per Capita ◽  
Prevalence Rates ◽  
Eye Care ◽  
Care Needs ◽  
Per Capita

Background/aimsTo estimate 2015 global ophthalmologist data and analyse their relationship to income groups, prevalence rates of blindness and visual impairment and gross domestic product (GDP) per capita.MethodsOnline surveys were emailed to presidents/chairpersons of national societies of ophthalmology and Ministry of Health representatives from all 194 countries to capture the number and density (per million population) of ophthalmologists, the number/density performing cataract surgery and refraction, and annual ophthalmologist population growth trends. Correlations between these data and income group, GDP per capita and prevalence rates of blindness and visual impairment were analysed.ResultsIn 2015, there were an estimated 232 866 ophthalmologists in 194 countries. Income was positively associated with ophthalmologist density (a mean 3.7 per million population in low-income countries vs a mean 76.2 in high-income countries). Most countries reported positive growth (94/156; 60.3%). There was a weak, inverse correlation between the prevalence of blindness and the ophthalmologist density. There were weak, positive correlations between the density of ophthalmologists performing cataract surgery and GDP per capita and the prevalence of blindness, as well as between GDP per capita and the density of ophthalmologists doing refractions.ConclusionsAlthough the estimated global ophthalmologist workforce appears to be growing, the appropriate distribution of the eye care workforce and the development of comprehensive eye care delivery systems are needed to ensure that eye care needs are universally met.

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