scholarly journals PO 7151 COMPARING TWO BED NET DELIVERY MODELS IN’RURAL DISTRICTS OF MOZAMBIQUE

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A19.3-A19
Author(s):  
Jorge Arroz
Keyword(s):  
Cost Effectiveness ◽  
Implementation Strategies ◽  
Cost Effective ◽  
Universal Coverage ◽  
Bed Net ◽  
Net Benefit ◽  
Previous Night ◽  
Before And After ◽  
New Strategy ◽  
Delivery Models

BackgroundThe use of long-lasting insecticidal nets (LLINs) is associated with a reduction in malaria transmission. In 2015, a new delivery strategy (intervention) for universal coverage campaign was tested and compared with standard strategy (control). The objective is to compare two bed net delivery models in rural districts of Mozambique.MethodsTwo districts served as intervention, and two as control. The following study design was used: 1) before and after; and 2) cost-effectiveness analysis. Three core implementation strategies were tested: 1) use of coupons during household registration, 2) use of stickers to identify registered houses, and 3) a new LLINs allocation criterion. The main endpoints measured were: i) percentage of distributed LLINs; ii) LLINs ownership and use coverage; iii) percentage of households that achieved universal coverage; iv) incremental cost-effectiveness ratio (ICER); v) incremental net benefit (INB).ResultsApproximately 88% (302,648) of LLINs were distributed in intervention districts compared to 77% (219,613) in control districts [OR: 2.14 (95% CI: 2.11–2.16)]. Six months after the 2015 campaign, 98.8% of the 760 households surveyed in the intervention districts had at least one LLIN; 89.6% of the 787 households surveyed in the control districts had at least one LLIN [OR: 9.7, (95% CI: 5.25–22.76)]. Near 95% and 87% of respondents who had at least one LLIN, reported having slept under the LLIN the previous night in the intervention and control districts, respectively [OR: 3.2; (95% CI 2.12–4.69)]; 71% of the households surveyed achieved universal coverage in the intervention districts against 59.6% in the control districts [OR: 1.6; (95% CI: 1.33–2.03)]. ICER per distributed LLIN was US$ 0.68. INB was positive.ConclusionIntervention districts had greater LLINs availability, greater LLINs ownership and use coverage, and a better progression toward reaching universal coverage targets. The new strategy was more cost-effective than the previous strategy.

scholarly journals Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Jorge A. H. Arroz ◽  
Baltazar Candrinho ◽  
Chandana Mendis ◽  
Melanie Lopez ◽  
Maria do Rosário O. Martins
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Universal Coverage ◽  
Cost Effectiveness Ratio ◽  
Net Benefit ◽  
Incremental Net Benefit ◽  
The Cost ◽  
And Control ◽  
Delivery Models ◽  
Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs. new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

scholarly journals Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

2019 ◽  
Author(s):  
Jorge Arroz ◽  
Baltazar Candrinho ◽  
Chandana Mendis ◽  
Melanie Lopez ◽  
Maria do Rosário Oliveira Martins
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Universal Coverage ◽  
Cost Effectiveness Ratio ◽  
Net Benefit ◽  
Incremental Net Benefit ◽  
The Cost ◽  
And Control ◽  
Delivery Models ◽  
Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

scholarly journals Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

2019 ◽  
Author(s):  
Jorge Arroz ◽  
Baltazar Candrinho ◽  
Chandana Mendis ◽  
Melanie Lopez ◽  
Maria do Rosário Oliveira Martins
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Universal Coverage ◽  
Cost Effectiveness Ratio ◽  
Net Benefit ◽  
Incremental Net Benefit ◽  
The Cost ◽  
And Control ◽  
Delivery Models ◽  
Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

scholarly journals Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

2019 ◽  
Author(s):  
Jorge Arroz ◽  
Baltazar Candrinho ◽  
Chandana Mendis ◽  
Melanie Lopez ◽  
Maria do Rosário Oliveira Martins
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Universal Coverage ◽  
Cost Effectiveness Ratio ◽  
Net Benefit ◽  
Incremental Net Benefit ◽  
The Cost ◽  
And Control ◽  
Delivery Models ◽  
Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

The Cost-Effectiveness of an RCT to Establish Whether 5 or 10 Years of Bisphosphonate Treatment Is the Better Duration for Women With a Prior Fracture

2009 ◽  
Vol 29 (6) ◽  
pp. 678-689 ◽  
Author(s):  
Matt D. Stevenson ◽  
Jeremy E. Oakley ◽  
Myfawny Lloyd Jones ◽  
Alan Brennan ◽  
Juliet E. Compston ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Fracture Prevention ◽  
Published Data ◽  
Bisphosphonate Treatment ◽  
Net Benefit ◽  
England And Wales ◽  
Term Efficacy ◽  
The Cost

Purpose. Five years of bisphosphonate treatment have proven efficacy in reducing fractures. Concerns exist that long-term bisphosphonate treatment may actually result in an increased number of fractures. This study evaluates, in the context of England and Wales, whether it is cost-effective to conduct a randomized controlled trial (RCT) and what sample size may be optimal to estimate the efficacy of bisphosphonates in fracture prevention beyond 5 years. Method. An osteoporosis model was constructed to evaluate the cost-effectiveness of extending bisphosphonate treatment from 5 years to 10 years. Two scenarios were run. The 1st uses long-term efficacy data from published literature, and the 2nd uses distributions elicited from clinical experts. Results of a proposed RCT were simulated. The expected value of sample information technique was applied to calculate the expected net benefit of sampling from conducting such an RCT at varying levels of participants per arm and to compare this with proposed trial costs. Results. Without further information, the better duration of bisphosphonate treatment was estimated to be 5 years using the published data but 10 years using the elicited expert opinions, although in both cases uncertainty was substantial. The net benefit of sampling was consistently high when between 2000 and 5000 participants per arm were recruited. Conclusions. An RCT to evaluate the long-term efficacy of bisphosphonates in fracture prevention appears to be cost-effective for informing decision making in England and Wales.

scholarly journals Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial

2004 ◽  
Vol 185 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Paul McCrone ◽  
Martin Knapp ◽  
Judith Proudfoot ◽  
Clash Ryden ◽  
Kate Cavanagh ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Quality Adjusted Life Year ◽  
Anxiety And Depression ◽  
Net Benefit ◽  
Cognitive Behavioural

BackgroundCognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative.AimsTo assess the cost-effectiveness of computer-delivered CBT.MethodA sample of people with depression or anxiety were randomised to usual care (n= 128) or computer-delivered CBT (n= 146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach.ResultsService costs were £40 (90% CI-£28 to £148) higher over 8 months for computer-delivered CBT. Lost-employment costs were £407 (90% CI £196 to £586) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at £40, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year.ConclusionsComputer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.

scholarly journals Phototherapy versus Occlusal Splint to control painful symptoms in Temporomandibular Disorder: controlled, randomized cost-effectiveness clinical trial

2020 ◽  
Vol 9 (11) ◽  
pp. e66991110251
Author(s):  
Ana Paula Taboada Sobral ◽  
Sergio de Sousa Sobral ◽  
Glaucia Gurnhak Giacon ◽  
Thalita Molinos Campos ◽  
Anna Carolina Ratto Tempestini Horliana ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cost Effectiveness ◽  
Pain Intensity ◽  
Myofascial Pain ◽  
Positive Impact ◽  
Temporomandibular Disorder ◽  
Cost Effective ◽  
Cost Ratio ◽  
Occlusal Splint ◽  
Before And After

Objective: To compare the efficacy of photobiomodulation and occlusal splint in patients with TMD-associated myofascial pain. Material and methods: 23 patients were randomized into 2 groups: laser group (LG) (n = 12) and occlusal splint group (OSG) (n=11). For the LG, laser was applied to 3 points on each side of the face. Twelve applications were made, 2 sessions per week. In the OSG, patients were instructed to use the device during sleep, 8 hours per night, for a period of 6 weeks, and 12 adjustment and follow-up sessions were performed. Patients in both groups were reevaluated 30 days after the end of the treatments. Results: There was a decrease in pain intensity, according to a visual analogue scale, in both groups before and after 1 month (LG, p = 0.008 and OSG p = 0.002), but with no difference between groups. For the quality of life, both treatments had a positive impact, with this impact being higher in the LG compared to the OSG (p <0.05). Regarding the cost-effectiveness analysis, laser was more cost-effective than the occlusal splint in the clinical trial. The incremental cost of the laser was $3,483.45 compared to the splint, but it had a cost ratio of $4,569.02 for controlled pain intensity while the splint showed $6,691.91 ratio for controlled pain intensity. Conclusion: The photobiomodulation was more cost-effective in controlling painful symptoms in patients with TMD and myofascial pain.

scholarly journals Risk-Benefit and Cost-Effectiveness of Universal Iron Interventions for Public Health Control of Anemia in Young Children in 78 Countries: A Microsimulation Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2276-2276 ◽  
Author(s):  
Sant-Rayn Pasricha ◽  
Adrian Gheorghe ◽  
Fayrouz Ashour ◽  
Amrita Arcot ◽  
Laura E Murray-Kolb ◽  
...  
Keyword(s):  
Latin America ◽  
Cost Effectiveness ◽  
Middle East ◽  
Young Children ◽  
Burkina Faso ◽  
Cost Effective ◽  
Asia Pacific ◽  
Net Benefit ◽  
Iron Supplements ◽  
Country Specific

Abstract Almost 300 million children worldwide are anemic. Universal distribution of iron interventions (iron supplements or iron-containing multiple micronutrient powders, MNPs) to young children (e.g. <2 years of age) is a key World Health Organization recommendation to prevent anemia in low-income countries. However, concerns of iron-induced infection risk and limited effectiveness for anemia and broader child health outcomes have raised questions about whether iron interventions produce a net health benefit and are cost-effective. This has constrained implementation. Net effects likely differ in each country according to the epidemiology of anemia and infection, and local health care costs. Quality of implementation likely also affects net benefit. This means analyses must be country-specific. To help guide policymakers, we estimated country-specific net benefit-risk and cost-effectiveness of universal intervention with MNPs or iron supplements to young children. We developed a bespoke microsimulation model to estimate country-specific net Disability Adjusted Life Years (DALYs) attributable to anemia and infection in children from age 0-18 months who received MNPs, iron supplements or control from age 6-12 months. The model utilised publically available data on anemia, malaria, diarrhoea and respiratory infection epidemiology, and modified their risks according to effect sizes from the pivotal systematic reviews of randomised trials used to inform current guidelines. We next estimated corresponding cost/ DALY averted. We modeled all 78 countries (46 in Africa, 20 in Asia and 12 in Latin America) where WHO reported that anemia prevalence exceeded 40% in 2011, or where pilot iron intervention programmes have been reported to be in place. We found that MNPs and iron supplements produced a net benefit to health in all countries, though the magnitude was heterogeneous.DALYs averted/ 10,000 children in Africa ranged from 20.2 (Egypt) to 81.8 (Burkina Faso), median 49.8; in Asia/Pacific/the Middle East from 22.7 (China) to 110.1 (Yemen), median 33.4, and in Latin America from 14.1 (Ecuador) to 68.5 (Bolivia), median 26.5.The median benefit from iron supplements in Africa was 76.4 DALYs averted/10,000 children and ranged from 39.7 in Zimbabwe to 111.6 in Burkina Faso; in Asia/Pacific/Middle East the median benefit was 71.7, ranging from 36.9 in the Phillipines to 133.3 in Pakistan and 133.0 in Yemen; and in Latin America the median benefit was 59.1, ranging from 93.5 in Bolivia to 39.5 in Guatemala. The magnitude of net benefit from MNPs and iron supplements on DALYs was strongly positively associated with the prevalence of moderate anemia (e.g. for MNPs: r=0.82, P=2.3x10-20). In Africa, MNPs cost between $961-$4341/DALY averted; in Asia/Middle-East/Pacific between $844-$3975/DALY averted, and in Latin America between $1306-$6566/DALY averted. The 10 countries where MNPs are most cost-effective were Yemen ($844/DALY averted), Burkina Faso ($961), Mauritania ($1119), The Gambia ($1165), Guinea-Bissau ($1165), Senegal ($1193), Mali ($1197), Guinea ($1267), and Ghana ($1273). Suboptimal coverage markedly reduced both DALYs averted and cost-effectiveness. The severity, not just overall prevalence of anemia, should be considered when planning a programme. Optimisation of programme coverage is essential to maximise cost-effectiveness. Our results augment existing guidelines and identify locations where iron interventions have the greatest benefit and are most cost-effective. Figure Legend Caterpillar plots and regional maps demonstrating DALYs averted/ 10,000 children for A) Multiple Micronutrient Powders, and b) Iron Supplements. Disclosures No relevant conflicts of interest to declare.

scholarly journals Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies

2020 ◽  
Author(s):  
Andria B Eisman ◽  
David Hutton ◽  
Lisa Prosser ◽  
Shawna Smith ◽  
Amy Kilbourne
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Implementation Strategy ◽  
Technical Assistance ◽  
Implementation Strategies ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Implementation Support ◽  
Life Years ◽  
Effective Programs

Abstract Background: Theory-based methods to support the uptake of evidence-based practices (EBPs) are critical to improving mental health outcomes. Implementation strategy costs can be substantial, and few have been rigorously evaluated. The purpose of this study is to conduct a cost-effectiveness analysis to identify the most cost-effective approach to deploying implementation strategies to enhance the uptake of Life Goals, a mental health EBP. Methods: We used data from a previously conducted randomized trial to compare the cost-effectiveness of Replicating Effective Programs (REP) combined with external and/or internal facilitation among sites non-responsive to REP. REP is a low-level strategy that includes EBP packaging, training, and technical assistance. External facilitation (EF) involves external expert support, and internal facilitation (IF) augments EF with protected time for internal staff to support EBP implementation. We developed a decision tree to assess 1-year costs and outcomes for four implementation strategies: 1) REP only, 2) REP+EF 3) REP+EF add IF if needed, 4) REP+EF/IF. The analysis used a 1-year time horizon and assumed a health payer perspective. Our outcome was quality-adjusted life years (QALYs). The economic outcome was the incremental cost-effectiveness ratio (ICER). We conducted deterministic and probabilistic sensitivity analysis (PSA). Results: Our results indicate that REP+EF add IF is the most cost-effective option with an ICER of $593/QALY. The REP+EF/IF and REP+EF only conditions are dominated (i.e., more expensive and less effective than comparators). One-way sensitivity analyses indicate that results are sensitive to utilities for REP+EF and REP+EF add IF. The PSA results indicate that REP+EF, add IF is the optimal strategy in 30% of iterations at the threshold of $100,000/QALY. Conclusions: Our results suggest that the most cost-effective implementation support begins with a less intensive, less costly strategy initially and increases as needed to enhance EBP uptake. Using this approach, implementation support resources can be judiciously allocated to those clinics that would most benefit. Our results were not robust to changes in the utility measure. Research is needed that incorporates robust and relevant utilities in implementation studies to determine the most cost-effective strategies. This study advances economic evaluation of implementation by assessing costs and utilities across multiple implementation strategy combinations.

Cost-effectiveness analysis of icotinib versus whole-brain irradiation with or without chemotherapy in EGFR-mutant NSCLC patients with brain metastases.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20556-e20556
Author(s):  
Wenqian Li ◽  
Rilan Bai ◽  
Lei Qian ◽  
Naifei Chen ◽  
Yuguang Zhao ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Brain Metastases ◽  
Kinase Inhibitors ◽  
Growth Factor Receptor ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Net Benefit ◽  
Whole Brain Irradiation ◽  
Nsclc Patients ◽  
The Impact

e20556 Background: Non-small-cell lung cancer (NSCLC) patients with brain metastases had a poor prognosis. Despite the traditional methods including radiotherapy and chemotherapy, epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) might benefit patients on survival and quality of life. We investigated the cost-effectiveness of icotinib compared with WBI with or without chemotherapy for NSCLC patients with brain metastases. Methods: A markov model was conducted based on the data of BRAIN trial. We compared the economic benefit between icotinib and the combination of WBI and WBI plus chemotherapy group. We considered disease progression as intracranial progression and overall progression separately. Sensitivity analyses were performed to observe the stability of the model. The willingness-to-pay (WTP) was set as 3× per capita gross domestic product ($25929/quality-adjusted life year [QALY]). Results: When considering progression as intracranial progression and overall progression respectively, the incremental cost-effectiveness ratio (ICER) was $930.17/QALY and $842.76/QALY between icotinib and WBI/WBI-chemotherapy. Besides, both of the average cost-effective ratio (average CE) and net benefit showed advantage of icotinib (average CE: $2157.59/QALY for intracranial progression, $2285.16/QALY for overall progression; net benefit: $372153.35 for intracranial progression, $349938.32 for overall progression). One-way sensitivity analyses demonstrated the impact of the utilities of icotinib group. The probabilistic sensitivity analyses showed even at a WTP under $6000/QALY, icotinib could be cost-effective. Conclusions: Icotinib was cost-effective compared with WBI with or without chemotherapy. [Table: see text]

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