scholarly journals Cost and cost-effectiveness of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low-income and middle-income countries: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029945 ◽  
Author(s):  
Olga PM Saweri ◽  
Neha Batura ◽  
Rabiah al Adawiyah ◽  
Louise Causer ◽  
Willie Pomat ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Point Of Care ◽  
Quality Of Reporting ◽  
Genital Infections ◽  
Middle Income ◽  
Sexually Transmitted ◽  
Reporting Practices ◽  
Middle Income Countries ◽  
In Pregnancy

IntroductionThe economic and health burden of sexually transmitted and genital infections (henceforth, STIs) in low-income and middle-income countries (LMICs) is substantial. Left untreated, STIs during pregnancy may result in several adverse pregnancy and birth outcomes. Timely diagnosis and treatment at point-of-care (POC) can potentially improve these outcomes. Despite the availability and promotion of POC diagnostics for STIs as a key component of antenatal care in LMICs, their widespread use has been limited, owing to the high economic costs faced by individuals and health systems. To date, there have been no systematic reviews which explore the cost or cost-effectiveness of POC testing and treatment of STIs in pregnancy in LMICs. The objective of this protocol is to outline the methods that will compare, synthesise and appraise the existing literature in this domain.Methods and analysisWe will conduct literature searches in MEDLINE, Embase and Web of Science. To find additional literature, we will search Google Scholar and hand search reference lists of included papers. Two reviewers will independently search databases, screen titles, abstracts and full texts; when necessary a third reviewer will resolve disputes. Only cost and cost-effectiveness studies of POC testing and treatment of STIs, including syphilis, chlamydia, trichomonas, gonorrhoea and bacterial vaginosis, in pregnancy in LMICs will be included. Published checklists will be used to assess quality of reporting practices and methodological approaches. We will also assess risk of publication bias. Interstudy heterogeneity will be assessed and depending on variation between studies, a meta-analysis or narrative synthesis will be conducted.Ethics and disseminationEthical approval is not required as the review will use published literature. The results will be published in a peer-reviewed open source journal and presented at an international conference.PROSPERO registration numberCRD42018109072.

scholarly journals Economic evaluation of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low- and middle-income countries: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253135
Author(s):  
Olga P. M. Saweri ◽  
Neha Batura ◽  
Rabiah Al Adawiyah ◽  
Louise M. Causer ◽  
William S. Pomat ◽  
...  
Keyword(s):  
Point Of Care ◽  
Economic Evaluations ◽  
Reporting Standards ◽  
Point Of Care Testing ◽  
Genital Infections ◽  
Middle Income ◽  
Sexually Transmitted ◽  
Middle Income Countries ◽  
In Pregnancy ◽  
Low And Middle Income

Background Sexually transmitted and genital infections in pregnancy are associated with adverse pregnancy and birth outcomes. Point-of-care tests for these infections facilitate testing and treatment in a single antenatal clinic visit and may reduce the risk of adverse outcomes. Successful implementation and scale-up depends on understanding comparative effectiveness of such programmes and their comparative costs and cost effectiveness. This systematic review synthesises and appraises evidence from economic evaluations of point-of-care testing and treatment for sexually transmitted and genital infections among pregnant women in low- and middle-income countries. Methods Medline, Embase and Web of Science databases were comprehensively searched using pre-determined criteria. Additional literature was identified by searching Google Scholar and the bibliographies of all included studies. Economic evaluations were eligible if they were set in low- and middle-income countries and assessed antenatal point-of-care testing and treatment for syphilis, chlamydia, gonorrhoea, trichomoniasis, and/or bacterial vaginosis. Studies were analysed using narrative synthesis. Methodological and reporting standards were assessed using two published checklists. Results Sixteen economic evaluations were included in this review; ten based in Africa, three in Latin and South America and three were cross-continent comparisons. Fifteen studies assessed point-of-care testing and treatment for syphilis, while one evaluated chlamydia. Key drivers of cost and cost-effectiveness included disease prevalence; test, treatment, and staff costs; test sensitivity and specificity; and screening and treatment coverage. All studies met 75% or more of the criteria of the Drummond Checklist and 60% of the Consolidated Health Economics Evaluation Reporting Standards. Conclusions Generally, point-of-care testing and treatment was cost-effective compared to no screening, syndromic management, and laboratory-based testing. Future economic evaluations should consider other common infections, and their lifetime impact on mothers and babies. Complementary affordability and equity analyses would strengthen the case for greater investment in antenatal point-of-care testing and treatment for sexually transmitted and genital infections.

scholarly journals How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review

2020 ◽  
Vol 5 (4) ◽  
pp. e002094 ◽  
Author(s):  
Chris Smith ◽  
Michelle Helena van Velthoven ◽  
Nguyen Duc Truong ◽  
Nguyen Hai Nam ◽  
Vũ Phan Anh ◽  
...  
Keyword(s):  
Low Income ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Health Workers ◽  
Internet Access ◽  
Sources Of Information ◽  
Quality Of Reporting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Registration Number

BackgroundWe systematically reviewed the evidence on how primary healthcare workers obtain information during consultations to support decision-making for prescribing in low and lower middle-income countries.MethodsWe searched electronic databases, consulted the Healthcare Information For All network, hand searched reference lists, ran citation searches of included studies and emailed authors of identified papers. Two reviewers extracted data and appraised quality with relevant tools.ResultsOf 60 497 records found, 23 studies met our inclusion criteria. Fourteen studies were observational and nine were interventional. Frequently mentioned sources of information were books, leaflets, guidelines, aids and the internet. These sources were sometimes out of date and health workers reported being confused which to use. Internet access varied and even when it was available, use was limited by technical issues. Of the five electronic tools that were assessed, four had positive outcomes. Tools assisted prescribers with medicine selection and dosage calculations, which increased prescribing accuracy. The quality of reporting varied but was overall low.DiscussionStudies indicated a lack of up-to-date and relevant medicine information in low and lower middle-income settings. Internet-based sources appeared to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools showed promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers.PROSPERO registration numberCRD42018091088.

scholarly journals Cost-effectiveness of interventions to reduce the risk of healthcare-acquired infections in middle-income countries: A systematic review

2019 ◽  
Vol 20 (6) ◽  
pp. 266-273
Author(s):  
Pushpa Udayangani Gamalathge ◽  
Sanjeewa Kularatna ◽  
Hannah E Carter ◽  
Sameera Senanayake ◽  
Nicholous Graves
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Developed Countries ◽  
Healthcare Systems ◽  
Quality Of Reporting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Use Of Resources ◽  
The Cost

Background: Hospital-acquired infections (HAI) contribute to prolonged hospital stays and account for a substantial economic burden to healthcare systems. Middle-income countries (MICs) experience a greater burden of HAI than developed countries. Evidence on the cost-effectiveness of interventions to reduce HAI is required to inform decision-making in these settings. Aim: To synthesise the evidence on cost-effectiveness as related to HAI interventions in MICs and to assess the quality of this evidence. Methods: A systematic review of published literature on the cost-effectiveness of interventions to reduce the incidence of HAI in MICs between 2000 and 2018 was conducted. Results: Six studies met the pre-determined inclusion criteria. The studies were from three countries: Thailand; India; and Vietnam. The evidence suggests that interventions to reduce HAI are cost-effective and, in most cases, cost-saving to healthcare systems. The quality of the reporting varied across studies. Conclusions: The implementation of HAI prevention interventions appears to be a high value use of resources in MICs. There is a need for further cost-effectiveness analyses in a wider range of MICs in order to confirm these findings. Improved standardisation and quality of reporting is required.

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

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.

scholarly journals The Economics of HIV/AIDS in Low-Income Countries: The Case for Prevention

2006 ◽  
Vol 20 (3) ◽  
pp. 121-142 ◽  
Author(s):  
David Canning
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Treatment And Prevention ◽  
Prevention And Treatment ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Hiv Aids

There are two approaches to reducing the burden of sickness and death associated with the human immunodeficiency virus (HIV), which leads to acquired immunodeficiency syndrome (AIDS): treatment and prevention. Despite large international aid flows for HIV/AIDS, the needs for prevention and treatment in low- and middle-income countries outstrip the resources available. Thus, it becomes necessary to set priorities. With limited resources, should the focus of efforts to combat HIV/AIDS be on prevention or treatment? I discuss the range of prevention and treatment alternatives and examine their cost effectiveness. I consider various arguments that have been raised against the use of cost-effectiveness analysis in setting public policy priorities for the response to HIV/AIDS in developing countries. I conclude that promoting AIDS treatment using antiretrovirals in resource-constrained countries comes at a huge cost in terms of avoidable deaths that could be prevented through interventions that would substantially lower the scale of the epidemic.

scholarly journals Cost-effectiveness of club-foot treatment in low-income and middle-income countries by the Ponseti method

2016 ◽  
Vol 1 (1) ◽  
pp. e000023 ◽  
Author(s):  
Caris E Grimes ◽  
Hampus Holmer ◽  
Jane Maraka ◽  
Birhanu Ayana ◽  
Linda Hansen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Club Foot ◽  
Ponseti Method ◽  
Middle Income ◽  
Middle Income Countries
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