scholarly journals Advocating an attack against severe malaria: a cost-effectiveness analysis

2019 ◽  
Author(s):  
Scott Greenhalgh ◽  
Veda Chandwani
Keyword(s):  
Cost Effectiveness ◽  
Gut Microbiota ◽  
Severe Malaria ◽  
Malaria Incidence ◽  
Health Benefits ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
Fold Reduction ◽  
Life Years ◽  
Freeze Dried

Abstract Background: Recently a study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective. Methods: Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings. Results. Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.6 to $34.2 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 14-17 countries and very cost-effective in 1-7 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 25 countries and very cost-effective in 19 countries. Conclusion: Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.

scholarly journals Advocating an attack against severe malaria: a cost-effectiveness analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Scott Greenhalgh ◽  
Veda Chandwani
Keyword(s):  
Cost Effectiveness ◽  
Gut Microbiota ◽  
Severe Malaria ◽  
Malaria Incidence ◽  
Health Benefits ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
Fold Reduction ◽  
Life Years ◽  
Freeze Dried

Abstract Background A recent study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective. Methods Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings. Results Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15–19 countries and very cost-effective in 9–14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very cost-effective in 25 countries. Conclusion Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.

scholarly journals Advocating an attack against severe malaria: a cost-effectiveness analysis

2019 ◽  
Author(s):  
Scott Greenhalgh ◽  
Veda Chandwani
Keyword(s):  
Cost Effectiveness ◽  
Gut Microbiota ◽  
Severe Malaria ◽  
Malaria Incidence ◽  
Health Benefits ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
Fold Reduction ◽  
Life Years ◽  
Freeze Dried

Abstract Background Recently a study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective.Methods Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings.Results Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very cost-effective in 25 countries.Conclusion Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.

scholarly journals Economic evaluation of ‘Men on the Move’, a ‘real world’ community-based physical activity programme for men

2020 ◽  
Author(s):  
Liam Kelly ◽  
Michael Harrison ◽  
Noel Richardson ◽  
Paula Carroll ◽  
Tom Egan ◽  
...  
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Health Benefits ◽  
Cost Effective ◽  
Health Improvement ◽  
Community Based ◽  
Life Years ◽  
The Impact

Abstract Background Physical activity (PA) interventions capable of producing health benefits cost effectively are a public health priority across the Western world. ‘Men on the Move’ (MOM), a community-based PA intervention for men, demonstrated significant health benefits up to 52-weeks (W) post-baseline. This article details the economic evaluation of MOM with a view to determining its cost-effectiveness as a public health intervention to be rolled out nationally in Ireland. Methods Cost-effectiveness was determined by comparing the costs (direct and indirect) of the programme to its benefits, which were captured as the impact on quality-adjusted life-years (QALYs). For the benefits, cost–utility analysis was conducted by retrospectively adapting various health-related measures of participants to generate health states using Brazier et al.’s (2002) short form-6D algorithm. This in turn allowed for ‘utility measures’ to be generated, from which QALYs were derived. Results Findings show MOM to be cost-effective in supporting an ‘at risk’ cohort of men achieves significant improvements in aerobic fitness, weight loss and waist reduction. The total cost per participant (€125.82 for each of the 501 intervention participants), the QALYs gained (11.98 post-12-W intervention, or 5.3% health improvement per participant) and estimated QALYs ratio costs of €3723 represents a cost-effective improvement when compared to known QALY guidelines. Conclusions The analysis shows that the cost per QALY achieved by MOM is significantly less than the existing benchmarks of £20 000 and €45 000 in the UK and Ireland respectively, demonstrating MOM to be cost-effective.

scholarly journals Estimated Health Benefits, Costs, and Cost-Effectiveness of Eliminating Industrial Trans-Fatty acids in Australia

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1720-1720
Author(s):  
Matti Marklund ◽  
Miaobing Zheng ◽  
J Lennert Veerman ◽  
Jason H Y Wu
Keyword(s):  
Fatty Acids ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Trans Fatty Acids ◽  
Health Care Cost ◽  
Health Benefits ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Potential Cost ◽  
Life Years

Abstract Objectives To assess the potential cost-effectiveness, health gains, and effects on health equality of eliminating industrial trans-fatty acids (TFAs) from the Australian food supply. Methods Markov cohort models were used to estimate the cost-effectiveness and policy impact on (ischemic heart disease) IHD burden and health equity of a national ban of industrial TFAs in Australia. Intake of TFA was assessed using the 2011–2012 Australian National Nutrition and Physical Activity Survey. The IHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting (0.5% energy per day from TFA; corresponding to TFA intake only from non-industrial sources, e.g., dairy foods). Policy costs, avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and IHD-related healthcare costs saved were estimated over 10 years and lifetime of the adult Australian population. Cost-effectiveness was assessed by calculation of incremental cost-effectiveness ratios (ICER) using net policy cost and HALYs gained. Health benefits and health care cost changes were also assessed in subgroups based on socioeconomic status and remoteness. Results Elimination of industrial TFA was estimated to prevent 2,294 (95% uncertainty interval [UI]: 1,765; 2,851) IHD deaths and 9,931 (95% UI: 8,429; 11,532) IHD events over the first 10 years. The greatest health benefits were accrued to the most socioeconomically disadvantaged quintiles and among Australians living outside of major cities. The intervention was estimated to be cost-saving or cost-effective (i.e., ICER < 169,361 AUD/HALY) regardless of the time horizon, with ICERs of 1,073 (95% UI: dominant; 3,503) and 1,956 (95% UI: 1,010; 2,750) AUD/HALY over 10 years and life time, respectively. The TFA ban was estimated to be cost-saving or highly cost-effective in sensitivity analyses altering assumptions of post-intervention TFA intake, abundance of TFA-containing products, or discount rate. Conclusions A ban of industrial TFAs could avert substantial numbers of IHD events and deaths in Australia and will likely be a highly cost-effective strategy to reduce social-economic and urban-rural inequalities in health. Funding Sources National Health and Medical Research Council; and UNSW.

scholarly journals Healthcare Costs and Life-years Gained From Treatments Within the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) Trial on Cryptococcal Meningitis: A Comparison of Antifungal Induction Strategies in Sub-Saharan Africa

2019 ◽  
Vol 69 (4) ◽  
pp. 588-595 ◽  
Author(s):  
Tao Chen ◽  
Lawrence Mwenge ◽  
Shabir Lakhi ◽  
Duncan Chanda ◽  
Peter Mwaba ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Resource Use ◽  
Cryptococcal Meningitis ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
Cost Effectiveness Ratio ◽  
Parametric Bootstrapping ◽  
Life Years ◽  
Sub Saharan ◽  
The Cost

Abstract Background Mortality from cryptoccocal meningitis remains high. The ACTA trial demonstrated that, compared with 2 weeks of amphotericin B (AmB) plus flucystosine (5FC), 1 week of AmB and 5FC was associated with lower mortality and 2 weeks of oral flucanozole (FLU) plus 5FC was non-inferior. Here, we assess the cost-effectiveness of these different treatment courses. Methods Participants were randomized in a ratio of 2:1:1:1:1 to 2 weeks of oral 5FC and FLU, 1 week of AmB and FLU, 1 week of AmB and 5FC, 2 weeks of AmB and FLU, or 2 weeks of AmB and 5FC in Malawi, Zambia, Cameroon, and Tanzania. Data on individual resource use and health outcomes were collected. Cost-effectiveness was measured as incremental costs per life-year saved, and non-parametric bootstrapping was done. Results Total costs per patient were US $1442 for 2 weeks of oral FLU and 5FC, $1763 for 1 week of AmB and FLU, $1861 for 1 week of AmB and 5FC, $2125 for 2 weeks of AmB and FLU, and $2285 for 2 weeks of AmB and 5FC. Compared to 2 weeks of AmB and 5FC, 1 week of AmB and 5FC was less costly and more effective and 2 weeks of oral FLU and 5FC was less costly and as effective. The incremental cost-effectiveness ratio for 1 week of AmB and 5FC versus oral FLU and 5FC was US $208 (95% confidence interval $91–1210) per life-year saved. Clinical Trials Registration ISRCTN45035509. Conclusions Both 1 week of AmB and 5FC and 2 weeks of Oral FLU and 5FC are cost-effective treatments.

scholarly journals Cost-effectiveness of cardiovascular imaging for stable coronary heart disease

Heart ◽  
2020 ◽  
pp. heartjnl-2020-316990 ◽  
Author(s):  
Simon Walker ◽  
Edward Cox ◽  
Ben Rothwell ◽  
Colin Berry ◽  
Gerry P McCann ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cost Effectiveness ◽  
Magnetic Resonance ◽  
Health Benefits ◽  
Cost Effective ◽  
Nice Guidelines ◽  
Pretest Likelihood ◽  
Life Years ◽  
The Cost

ObjectiveTo assess the cost-effectiveness of management strategies for patients presenting with chest pain and suspected coronary heart disease (CHD): (1) cardiovascular magnetic resonance (CMR); (2) myocardial perfusion scintigraphy (MPS); and (3) UK National Institute for Health and Care Excellence (NICE) guideline-guided care.MethodsUsing UK data for 1202 patients from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 trial, we conducted an economic evaluation to assess the cost-effectiveness of CMR, MPS and NICE guidelines. Health outcomes were expressed as quality-adjusted life-years (QALYs), and costs reflected UK pound sterling in 2016–2017. Cost-effectiveness results were presented as incremental cost-effectiveness ratios and incremental net health benefits overall and for low, medium and high pretest likelihood of CHD subgroups.ResultsCMR had the highest estimated QALY gain overall (2.21 (95% credible interval 2.15, 2.26) compared with 2.07 (1.92, 2.20) for NICE and 2.11 (2.01, 2.22) for MPS) and incurred comparable costs (overall £1625 (£1431, £1824) compared with £1753 (£1473, £2032) for NICE and £1768 (£1572, £1989) for MPS). Overall, CMR was the cost-effective strategy, being the dominant strategy (more effective, less costly) with incremental net health benefits per patient of 0.146 QALYs (−0.18, 0.406) compared with NICE guidelines at a cost-effectiveness threshold of £15 000 per QALY (93% probability of cost-effectiveness). Results were similar in the pretest likelihood subgroups.ConclusionsCMR-guided care is cost-effective overall and across all pretest likelihood subgroups, compared with MPS and NICE guidelines.

scholarly journals Priority Setting in HIV, Tuberculosis, and Malaria – New Cost-Effectiveness Results From WHO-CHOICE

2021 ◽  
Author(s):  
Ambinintsoa H. Ralaidovy ◽  
Jeremy Addison Lauer ◽  
Carel Pretorius ◽  
Olivier JT Briët ◽  
Edith Patouillard
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
21St Century ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
World Health ◽  
Global Community ◽  
Development Goal ◽  
Life Years ◽  
The Cost

Background: This paper forms part of an update of the World Health Organization Choosing Interventions that are Cost-Effective (WHO-CHOICE) programmes. It provides an assessment of global health system performance during the first decade of the 21st century (2000-2010) with respect to allocative efficiency in HIV, tuberculosis (TB) and malaria control, thereby shining a spotlight on programme development and scale up in these Millennium Development Goal (MDG) priority areas; and examining the cost-effectiveness of selected best-practice interventions and intervention packages commonly in use during that period. Methods: Generalized cost-effectiveness analysis (GCEA) was used to determine the cost-effectiveness of the selected interventions. Impact modelling was performed using the OpenMalaria platform for malaria and using the Goals and TIME (TB Impact Model and Estimates) models in Spectrum for HIV and TB. All health system costs, regardless of payer, were included and reported in international dollars. Health outcomes are estimated and reported as the gain in healthy life years (HLYs) due to the specific intervention or combination. Analysis was restricted to eastern sub-Saharan Africa and Southeast Asia. Results: At the reference year of 2010, commonly used interventions for HIV, TB and malaria were cost-effective, with cost-effectiveness ratios less than I$ 100/HLY saved for virtually all interventions included. HIV, TB and malaria prevention and treatment interventions are highly cost-effective and can be implemented through a phased approach to full coverage to achieve maximum health benefits and contribute to the progressive elimination of these diseases. Conclusion: During the first decade of the 21st century (2000-2010), the global community has done well overall for HIV, TB, and malaria programmes as regards both economic efficiency and programmatic selection criteria. The role of international assistance, financial and technical, arguably was critical to these successes. As the global community now tackles the challenge of universal health coverage, this analysis can reinforce commitment to Sustainable Development Goal targets but also the importance of continued focus on these critical programme areas.

scholarly journals Prevention and control of dengue and Chikungunya in Colombia: A cost-effectiveness analysis

2021 ◽  
Vol 15 (12) ◽  
pp. e0010086
Author(s):  
Anneke L. Claypool ◽  
Margaret L. Brandeau ◽  
Jeremy D. Goldhaber-Fiebert
Keyword(s):  
Cost Effectiveness ◽  
Health Benefits ◽  
Cost Effective ◽  
Emerging Diseases ◽  
Transmission Model ◽  
Insecticide Treated Nets ◽  
Transmission Parameters ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Current Price

Background Chikungunya and dengue are emerging diseases that have caused large outbreaks in various regions of the world. Both are both spread by Aedes aegypti and Aedes albopictus mosquitos. We developed a dynamic transmission model of chikungunya and dengue, calibrated to data from Colombia (June 2014 –December 2017). Methodology/Principal findings We evaluated the health benefits and cost-effectiveness of residual insecticide treatment, long-lasting insecticide-treated nets, routine dengue vaccination for children aged 9, catchup vaccination for individuals aged 10–19 or 10–29, and portfolios of these interventions. Model calibration resulted in 300 realistic transmission parameters sets that produced close matches to disease-specific incidence and deaths. Insecticide was the preferred intervention and was cost-effective. Insecticide averted an estimated 95 chikungunya cases and 114 dengue cases per 100,000 people, 61 deaths, and 4,523 disability-adjusted life years (DALYs). In sensitivity analysis, strategies that included dengue vaccination were cost-effective only when the vaccine cost was 14% of the current price. Conclusions/Significance Insecticide to prevent chikungunya and dengue in Columbia could generate significant health benefits and be cost-effective. Because of limits on diagnostic accuracy and vaccine efficacy, the cost of dengue testing and vaccination must decrease dramatically for such vaccination to be cost-effective in Colombia. The vectors for chikungunya and dengue have recently spread to new regions, highlighting the importance of understanding the effectiveness and cost-effectiveness of policies aimed at preventing these diseases.

scholarly journals Cost-effectiveness of early versus delayed antiretroviral therapy in tuberculosis patients infected with HIV in sub-Saharan Africa

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 253
Author(s):  
Rashidah T. Uthman ◽  
Olalekan A. Uthman
Keyword(s):  
Cost Effectiveness ◽  
Antiretroviral Therapy ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
Qaly Gain ◽  
Base Case ◽  
Decision Analytic Model ◽  
Life Years ◽  
Sub Saharan ◽  
The Cost

Background: The most challenging issue physicians are facing is the appropriate timing of introducing antiretroviral therapy (ART) along with ongoing tuberculosis (TB) therapy in HIV and TB co-infected patients. This study examined the cost-effectiveness of early versus delayed ART initiation in TB patients, infected with HIV (co-infected patients) in a sub-Saharan Africa setting. Methods: A decision analytic model based on previously published and real-world evidence was applied to evaluate clinical and economic outcomes associated with early versus delayed ART in TB and HIV co-infection. Incremental cost-effectiveness ratio (ICER) was calculated with both costs and quality-adjusted life years (QALYs). Different assumptions of treatment benefits and costs were taken to address uncertainties and were tested with sensitivity analyses. Results: In base case analysis, the expected cost of giving early ART to TB patients infected with HIV was $1372, with a QALY gain of 0.68, while the cost of delayed ART was $955, with a QALY gain of 0.62. The ICER shows $6775 per QALYs, which suggests that it is not as cost-effective, since it is greater than 3 x GDP per capita ($5,086) for sub-Saharan Africa willingness to pay (WTP) threshold. At $10,000 WTP, the probability that early ART is cost effective compared to delayed ART is 0.9933. At cost-effectiveness threshold of $5086, the population expected value of perfect information becomes substantial (≈US$5 million), and is likely to exceed the cost of additional investigation. This suggests that further research will be potentially cost-effective. Conclusions: From the perspective of the health-care payer in sub-Saharan Africa, early initiation of ART in HIV and TB co-infection cannot be regarded as cost-effective based on current information. The analysis shows that further research will be worthwhile and potentially cost-effective in resolving uncertainty about whether or not to start ART early in HIV and TB co-infection.

scholarly journals Cost-effectiveness of an indicated preventive intervention for depression in adolescents

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Ssegonja ◽  
F Sampaio ◽  
I Alaie ◽  
A Philipson ◽  
L Hagberg ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Preventive Intervention ◽  
Health Benefits ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Preventive Interventions ◽  
Subsyndromal Depression ◽  
Life Years

Abstract Background Adolescent depression has negative health and economic outcomes in the short- and long-term. Indicated preventive interventions, in particular group based cognitive behavioural therapy (GB-CBT), are effective in preventing depression in adolescents with subsyndromal depression. However, little is known about the cost-effectiveness of these interventions. Methods A Markov cohort model was used to conduct cost-effectiveness analyses comparing a GB-CBT indicated preventive intervention for depression, to a no-intervention option. Taking a time horizon of 5- and 10 years, incremental differences in societal costs and health benefits expressed as cases of depression prevented, and as quality adjusted life years (QALYs) gained were estimated. Through univariate and probabilistic sensitivity analyses, the robustness of the results was explored. Costs, presented in 2018 USD, and effects were discounted at a yearly rate of 3%. Results The base-case analysis showed that GB-CBT indicated preventive intervention incurred lower costs, prevented more cases of depression and generated higher QALYs compared to the no-intervention option for both time horizons. Offering the intervention was even a cost saving strategy and demonstrated a probability of being cost-effective of over 95%. In the sensitivity analyses, these results were robust to the modelling assumptions. Limitations: The study considered a homogeneous cohort and assumed a constant annual decay rate of the relative treatment effect. Conclusions GB-CBT indicated preventive interventions for depression in adolescence can generate good value for money compared to leaving adolescents with subsyndromal depression untreated. Key messages Indicated preventive interventions for depression are cost-saving and can generate substantial health benefits. Indicated preventive interventions can be adopted as cost-effective preventive strategies for depression.

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