Comparison of the Estimated Cost-Effectiveness of Preventive and Therapeutic Zinc Supplementation Strategies for Reducing Child Morbidity and Mortality in Sub-Saharan Africa

Improvement of antiretroviral therapy (ART) regimen switching practices and implementation of pretreatment drug resistance (PDR) testing are two potential approaches to improve health outcomes for children living with HIV. We developed a microsimulation model of disease progression and treatment focused on children with perinatally acquired HIV in sub-Saharan Africa who initiate ART at 3 years of age. We evaluated the cost-effectiveness of diagnostic-based strategies (improved switching and PDR testing), over a 10-year time horizon, in settings without and with pediatric dolutegravir (DTG) availability as first-line ART. The improved switching strategy increases the probability of switching to second-line ART when virologic failure is diagnosed through viral load testing. The PDR testing strategy involves a one-time PDR test prior to ART initiation to guide choice of initial regimen. When DTG is not available, PDR testing is dominated by the improved switching strategy, which has an incremental cost-effectiveness ratio (ICER) of USD 579/life-year gained (LY), relative to the status quo. If DTG is available, improved switching has a similar ICER (USD 591/LY) relative to the DTGstatus quo. Even when substantial financial investment is needed to achieve improved regimen switching practices, the improved switching strategy still has the potential to be cost-effective in a wide range of sub-Saharan African countries. Our analysis highlights the importance of strengthening existing laboratory monitoring systems to improve the health of children living with HIV.

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Are low and middle-income countries prioritising high-value healthcare interventions?

BMJ Global Health ◽

10.1136/bmjgh-2019-001850 ◽

2020 ◽

Vol 5 (2) ◽

pp. e001850

Author(s):

Ashley A Leech ◽

David D Kim ◽

Joshua T Cohen ◽

Peter J Neumann

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

National Health ◽

Sub Saharan Africa ◽

Health Plans ◽

Middle Income ◽

Middle Income Countries ◽

Health Priority ◽

Sub Saharan ◽

Low And Middle Income

IntroductionSince resources are finite, investing in services that produce the highest health gain ‘return on investment’ is critical. We assessed the extent to which low and middle-income countries (LMIC) have included cost-saving interventions in their national strategic health plans.MethodsWe used the Tufts Medical Center Global Health Cost-Effectiveness Analysis Registry, an open-source database of English-language cost-per-disability-adjusted life year (DALY) studies, to identify analyses published in the last 10 years (2008–2017) of cost-saving health interventions in LMICs. To assess whether countries prioritised cost-saving interventions within their latest national health strategic plans, we identified 10 countries, all in sub-Saharan Africa, with the highest measures on the global burden of disease scale and reviewed their national health priority plans.ResultsWe identified 392 studies (63%) targeting LMICs that reported 3315 cost-per-DALY ratios, of which 207 ratios (6%) represented interventions reported to be cost saving. Over half (53%) of these targeted sub-Saharan Africa. For the 10 countries we investigated in sub-Saharan Africa, 58% (79/137) of cost-saving interventions correspond with priorities identified in country plans. Alignment ranged from 95% (21/22 prioritised cost-saving ratios) in South Africa to 17% (2/12 prioritised cost-saving ratios) in Cameroon. Human papillomavirus vaccination was a noted priority in 70% (7/10) of national health prioritisation plans, while 40% (4/10) of countries explicitly included prenatal serological screening for syphilis. HIV prevention and treatment were stated priorities in most country health plans, whereas 40% (2/5) of countries principally outlined efforts for lymphatic filariasis. From our sample of 45 unique interventions, 36% of interventions (16/45) included costs associated directly with the implementation of the intervention.ConclusionOur findings indicate substantial variation across country and disease area in incorporating economic evidence into national health priority plans in a sample of sub-Saharan African countries. To make health economic data more salient, the authors of cost-effectiveness analyses must do more to reflect implementation costs and other factors that could limit healthcare delivery.

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Cost-Effectiveness of the Introduction of a Pre-Erythrocytic Malaria Vaccine into the Expanded Program on Immunization in Sub-Saharan Africa: Analysis of Uncertainties Using a Stochastic Individual-Based Simulation Model of Plasmodium falciparum Malaria

Value in Health ◽

10.1016/j.jval.2011.06.004 ◽

2011 ◽

Vol 14 (8) ◽

pp. 1028-1038 ◽

Cited By ~ 20

Author(s):

Nicolas Maire ◽

Samuel D. Shillcutt ◽

Damian G. Walker ◽

Fabrizio Tediosi ◽

Thomas A. Smith

Keyword(s):

Plasmodium Falciparum ◽

Cost Effectiveness ◽

Simulation Model ◽

Falciparum Malaria ◽

Malaria Vaccine ◽

Plasmodium Falciparum Malaria ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Individual Based Simulation ◽

Expanded Program On Immunization

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Cost‐Effectiveness of Laboratory Monitoring in Sub‐Saharan Africa: A Review of the Current Literature

Clinical Infectious Diseases ◽

10.1086/653119 ◽

2010 ◽

Vol 51 (1) ◽

pp. 85-92 ◽

Cited By ~ 29

Author(s):

Rochelle P. Walensky ◽

Andrea L. Ciaranello ◽

Ji‐Eun Park ◽

Kenneth A. Freedberg

Keyword(s):

Cost Effectiveness ◽

Current Literature ◽

Sub Saharan Africa ◽

Laboratory Monitoring ◽

Sub Saharan

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The toll of COVID-19 on African children: A descriptive analysis on the COVID-19-related morbidity and mortality among the pediatric population in Sub-Saharan Africa

10.1101/2021.07.02.21259857 ◽

2021 ◽

Author(s):

Sabina Rodriguez Velasquez ◽

Lea Jacques ◽

Jyoti Dalal ◽

Paolo Sestito ◽

Zahra Habibi ◽

...

Keyword(s):

Cumulative Incidence ◽

Pediatric Population ◽

Adult Population ◽

Age Groups ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

African Countries ◽

Regional Office ◽

Sub Saharan ◽

Epidemiological Characteristics

Introduction: Since the beginning of the COVID-19 pandemic, very little data on the epidemiological characteristics among the pediatric population in Africa has been published. This paper examines the age and sex distribution of the morbidity and mortality rate in children with COVID-19 and compares it to the adult population within 15 Sub-Saharan African countries. Methods: A merge line listing dataset using a reverse engineering model shared by countries within the Regional Office for Africa was analyzed. Patients diagnosed within 1 March 2020 and 1 September 2020 with confirmed positive RT-PCR test for SARS-CoV-2 were analyzed. Children data were stratified into three age groups: 0-4 years, 5-11 years, and 12-17 years, while adults were combined. The cumulative incidence of cases including its medians and 95% confidence intervals were calculated. Results: 9% of the total confirmed cases and 2.4% of the reported deaths were pediatric cases. The 12-17 age group in all 15 countries showed the highest cumulative incidence proportion in children. COVID-19 cases in males and females under the age of 18 were evenly distributed. Among adults, a higher case incidence per 100,000 people was observed compared to children. Conclusion: The cases and deaths within the children population was smaller than the adult population. These differences can reflect biases in COVID-19 testing protocols and reporting implemented by countries, highlighting the need for more extensive investigation and focus on the effects of COVID-19 in children.

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Evaluating survey designs for targeting preventive chemotherapy against Schistosoma haematobium and Schistosoma mansoni across Sub-Saharan Africa: a geostatistical analysis and modelling study

10.21203/rs.3.rs-36950/v3 ◽

2020 ◽

Author(s):

Kimberly Fornace ◽

Claudio Fronterrè ◽

Fiona M Fleming ◽

Hope Simpson ◽

Honorat Zoure ◽

...

Keyword(s):

Cost Effectiveness ◽

Schistosoma Haematobium ◽

Sampling Strategy ◽

Sub Saharan Africa ◽

Spatial Distributions ◽

Preventive Chemotherapy ◽

School Based ◽

Control Programmes ◽

Sub Saharan ◽

Survey Designs

Abstract Background: Schistosomiasis control programmes primarily use school-based surveys to identify areas for mass drug administration of preventive chemotherapy. However, as the spatial distribution of schistosomiasis can be highly focal, transmission may not be detected by surveys implemented at districts or larger spatial units. Improved mapping strategies are required to accurately and cost-effectively target preventive chemotherapy to remaining foci across all possible spatial distributions of schistosomiasis. Methods: Here, we use geostatistical models to quantify the spatial heterogeneity of Schistosoma haematobium and S. mansoni across sub-Saharan Africa using the most comprehensive dataset available on school-based surveys. Applying this information to parameterise simulations, we assess the accuracy and cost of targeting alternative implementation unit sizes across the range of plausible schistosomiasis distributions. We evaluate the consequences of decisions based on survey designs implemented at district and subdistrict levels sampling different numbers of schools. Cost data were obtained from field surveys conducted across multiple countries and years, with cost effectiveness evaluated as the cost per correctly identified school. Results: Models identified marked differences in prevalence and spatial distributions between countries and species; however, results suggest implementing surveys at subdistrict level increase the accuracy of treatment classifications across most scenarios. While sampling intensively at the subdistrict level resulted in the highest classification accuracy, this sampling strategy resulted in the highest costs. Alternatively, sampling the same numbers of schools currently recommended at the district level but stratifying by subdistrict increased cost effectiveness.Conclusions: This study provides a new tool to evaluate schistosomiasis survey designs across a range of transmission settings. Results highlight the importance of considering spatial structure when designing sampling strategies, illustrating that a substantial proportion of children may be undertreated even when an implementation unit is correctly classified. Control programmes need to weigh the increased accuracy of more detailed mapping strategies against the survey costs and treatment priorities.

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Cost-effectiveness of malaria control in sub-Saharan Africa

The Lancet ◽

10.1016/s0140-6736(99)02141-8 ◽

1999 ◽

Vol 354 (9176) ◽

pp. 378-385 ◽

Cited By ~ 147

Author(s):

CA Goodman ◽

PG Coleman ◽

AJ Mills

Keyword(s):

Cost Effectiveness ◽

Malaria Control ◽

Sub Saharan Africa ◽

Sub Saharan

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The Need for the Right Socio-Economic and Cultural Fit in the COVID-19 Response in Sub-Saharan Africa: Examining Demographic, Economic Political, Health, and Socio-Cultural Differentials in COVID-19 Morbidity and Mortality

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103445 ◽

2020 ◽

Vol 17 (10) ◽

pp. 3445 ◽

Cited By ~ 14

Author(s):

Andre Renzaho

Keyword(s):

Global Economy ◽

Social Protection ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

Peace Building ◽

African Countries ◽

Cross Border ◽

Tax Regimes ◽

Sub Saharan ◽

Political Health

The coronavirus disease (COVID-19) has spread quickly across the globe with devastating effects on the global economy as well as the regional and societies’ socio-economic fabrics and the way of life for vast populations. The nonhomogeneous continent faces local contextual complexities that require locally relevant and culturally appropriate COVID-19 interventions. This paper examines demographic, economic, political, health, and socio-cultural differentials in COVID-19 morbidity and mortality. The health systems need to be strengthened through extending the health workforce by mobilizing and engaging the diaspora, and implementing the International Health Regulations (2005) core capacities. In the absence of adequate social protection and welfare programs targeting the poor during the pandemic, sub-Saharan African countries need to put in place flexible but effective policies and legislation approaches that harness and formalise the informal trade and remove supply chain barriers. This could include strengthening cross-border trade facilities such as adequate pro-poor, gender-sensitive, and streamlined cross-border customs, tax regimes, and information flow. The emphasis should be on cross-border infrastructure that not only facilitates trade through efficient border administration but can also effectively manage cross-border health threats. There is an urgent need to strengthen social protection systems to make them responsive to crises, and embed them within human rights-based approaches to better support vulnerable populations and enact health and social security benefits. The COVI-19 response needs to adhere to the well-established ‘do no harm’ principle to prevent further damage or suffering as a result of the pandemic and examined through local lenses to inform peace-building initiatives that may yield long-term gains in the post-COVID-19 recovery efforts.

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