scholarly journals Reducing regional inequality in community-based treatment of childhood pneumonia in Ethiopia: A sub-national distributional cost-effectiveness analysis

2020 ◽  
Author(s):  
Maria Olsen ◽  
Ole F. Norheim ◽  
Solomon Tessema Memirie
Keyword(s):  
Cost Effectiveness ◽  
Scenario Analysis ◽  
Scale Up ◽  
Scaling Up ◽  
Community Based ◽  
Childhood Pneumonia ◽  
Under Five ◽  
Geographical Inequalities ◽  
The Cost ◽  
Universal Scale

Abstract Background Scaling up coverage of community-based treatment of childhood pneumonia (CCM) is part of the strategy to promote equity and reduce under-five mortality rate (U5MR) in Ethiopia. However, urban children with symptoms of pneumonia are still more than twice as likely to receive treatment compared with rural children having similar symptoms. There are no sub-national cost-effectiveness analyses available to inform decision makers on the most equitable scale-up strategy. Objectives To model sub-national cost-effectiveness and inequality impacts of scaling up coverage of CCM in each of the 11 Ethiopian regions. We also explore three different scale-up strategies: reducing geographical inequalities, health maximization and universal scale-up. Methods For each region, we developed a Markov model and estimated the cost-effectiveness of scaling up coverage to 90 percent. Data inputs were collected through literature review. Effects were modeled as life years gained and under-five deaths averted. Inputs on unit costs were adjusted to the proportions of rural and urban population in each region. In scenario analysis, we estimated costs, health effects and, by the use of the Gini measure applied to health, the inequality impacts of three different scale-up strategies: 1) maximizing health by prioritizing the regions where the intervention was the most cost-effective, 2) reducing geographical inequality by prioritizing the regions with the highest baseline U5MR and 3) universally scaling up to 90% coverage in all the regions. Results Universal scale-up of CCM would cost about 1.3 billion USD and prevent about 90,000 under-five deaths. This is less than 15,000 USD per life saved and translates to an increase in life expectancy at birth of 1.6 years across Ethiopia. The regional incremental-cost effectiveness ratio (ICER) of scaling up the intervention coverage varied from 26 USD per life year gained in Addis to 199 USD per life year gained in the SNNP region. In scenario analysis, we found that prioritizing regions with high U5MR is effective in reducing geographical inequalities, although at the cost of some fewer lives saved. Conclusions Our model results illustrate a trade-off between maximizing health and reducing health inequalities, two common policy-aims in low-income settings.

scholarly journals Reducing regional health inequality: A sub-national distributional cost-effectiveness analysis of community-based treatment of childhood pneumonia in Ethiopia

2020 ◽  
Author(s):  
Maria Olsen ◽  
Ole F. Norheim ◽  
Solomon Tessema Memirie
Keyword(s):  
Cost Effectiveness ◽  
Life Expectancy ◽  
Health Effects ◽  
Scenario Analysis ◽  
Scale Up ◽  
Scaling Up ◽  
Community Based ◽  
Under Five ◽  
Life Expectancy At Birth ◽  
Geographical Inequalities

Abstract Background: Increasing the coverage of community-based treatment of childhood pneumonia (CCM) is part of the strategy to improve child survival, increase life-expectancy at birth and promote equity in Ethiopia. However, full coverage of CCM has not been reached in any regions of the country. There are no sub-national cost-effectiveness analyses available to inform decision makers on the most equitable scale up strategy.Objectives: Our first objective is to estimate the sub-national cost-effectiveness and the interindividual inequality impacts of scaling up CCM coverages to 90 percent in each region. Our second objective is to explore the costs, health effects, and geographical inequality impacts associated with three scale-up scenarios promoting different policy-aims: maximizing health, reducing geographical inequalities, and achieving 90% universal coverage.Methods: We used Markov modelling to estimate the sub-national cost-effectiveness of CCM in each region. All data were collected through literature review and adjusted to the region-specific proportions of the rural population. Health effects were modeled as life years gained and under-five deaths averted. Interindividual and geographical inequality impacts were measured by the GINI index applied to health. In scenario analysis we explored three different scale-up strategies: 1) maximizing health by prioritizing the regions where the intervention was the most cost-effective, 2) reducing geographical inequalities by prioritizing the regions with high baseline under-five mortality rate (U5MR), and 3) universal upscaling to 90% coverage in all the regions.Results: The regional incremental-cost effectiveness ratio (ICER) of scaling up the intervention coverage varied from 26 USD per life year gained in Addis to 199 USD per life year gained in the Southern Nations, Nationalities, and Peoples' region. Universal upscaling of CCM in all regions would cost about 1.3 billion USD and prevent about 90,000 under-five deaths. This is less than 15,000 USD per life saved and translates to an increase in life expectancy at birth of 1.6 years across Ethiopia. In scenario analysis, we found that prioritizing regions with high U5MR is effective in reducing geographical inequalities, although at the cost of fewer lives saved as compared to the health maximizing strategy.Conclusions: Our model results illustrate a trade-off between maximizing health and reducing health inequalities, two common policy-aims in low-income settings.

scholarly journals Reducing regional health inequality: a sub-national distributional cost-effectiveness analysis of community-based treatment of childhood pneumonia in Ethiopia

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Olsen ◽  
Ole F. Norheim ◽  
Solomon Tessema Memirie
Keyword(s):  
Cost Effectiveness ◽  
Life Expectancy ◽  
Health Effects ◽  
Scenario Analysis ◽  
Scale Up ◽  
Scaling Up ◽  
Community Based ◽  
Under Five ◽  
Life Expectancy At Birth ◽  
Geographical Inequalities

Abstract Background Increasing the coverage of community-based treatment of childhood pneumonia (CCM) is part of the strategy to improve child survival, increase life-expectancy at birth and promote equity in Ethiopia. However, full coverage of CCM has not been reached in any regions of the country. There are no sub-national cost-effectiveness analyses available to inform decision makers on the most equitable scale up strategy. Objectives Our first objective is to estimate the sub-national cost-effectiveness and the interindividual inequality impacts of scaling up CCM coverages to 90% in each region. Our second objective is to explore the costs, health effects, and geographical inequality impacts associated with three scale-up scenarios promoting different policy-aims: maximizing health, reducing geographical inequalities, and achieving 90% universal coverage. Methods We used Markov modelling to estimate the sub-national cost-effectiveness of CCM in each region. All data were collected through literature review and adjusted to the region-specific proportions of the rural population. Health effects were modeled as life years gained and under-five deaths averted. Interindividual and geographical inequality impacts were measured by the GINI index applied to health. In scenario analysis we explored three different scale-up strategies: 1) maximizing health by prioritizing the regions where the intervention was the most cost-effective, 2) reducing geographical inequalities by prioritizing the regions with high baseline under-five mortality rate (U5MR), and 3) universal upscaling to 90% coverage in all the regions. Results The regional incremental-cost effectiveness ratio (ICER) of scaling up the intervention coverage varied from 26 USD per life year gained in Addis to 199 USD per life year gained in the Southern Nations, Nationalities, and Peoples’ region. Universal upscaling of CCM in all regions would cost about 1.3 billion USD and prevent about 90,000 under-five deaths. This is less than 15,000 USD per life saved and translates to an increase in life expectancy at birth of 1.6 years across Ethiopia. In scenario analysis, we found that prioritizing regions with high U5MR is effective in reducing geographical inequalities, although at the cost of fewer lives saved as compared to the health maximizing strategy. Conclusions Our model results illustrate a trade-off between maximizing health and reducing health inequalities, two common policy-aims in low-income settings.

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

2021 ◽  
pp. 1357633X2098277
Author(s):  
Molly Jacobs ◽  
Patrick M Briley ◽  
Heather Harris Wright ◽  
Charles Ellis
Keyword(s):  
Cost Effectiveness ◽  
Economies Of Scale ◽  
Reference Group ◽  
Unit Cost ◽  
Community Based ◽  
Face To Face ◽  
Conduction Aphasia ◽  
Aphasia Treatment ◽  
The Cost ◽  
The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

scholarly journals The cost-effectiveness of a successful community-based obesity prevention program: The be active eat well program

Obesity ◽  
2013 ◽  
Vol 21 (10) ◽  
pp. 2072-2080 ◽  
Author(s):  
Marjory L. Moodie ◽  
Jessica K. Herbert ◽  
Andrea M. de Silva-Sanigorski ◽  
Helen M. Mavoa ◽  
Catherine L. Keating ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Obesity Prevention ◽  
Prevention Program ◽  
Community Based ◽  
The Cost ◽  
Obesity Prevention Program

scholarly journals Community interventions for people with complex emotional needs that meet the criteria for ‘personality disorder’ diagnoses: a systematic review of economic evaluations

2020 ◽  
Author(s):  
Joe Botham ◽  
Amy Clark ◽  
Thomas Steare ◽  
Ruth Stuart ◽  
Sian Oram ◽  
...  
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Personality Disorder ◽  
Economic Evaluations ◽  
Economic Evidence ◽  
Emotional Needs ◽  
Community Based Interventions ◽  
Community Based ◽  
Single Intervention ◽  
The Cost

AbstractBackgroundDiagnoses of “personality disorder” are prevalent among people using community secondary mental health services. Whilst the effectiveness of a range of community-based treatments have been considered, as the NHS budget is finite, it is also important to consider the cost-effectiveness of those interventions.AimsTo assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs that meet criteria for a diagnosis of “personality disorder” to inform healthcare policy making.MethodSystematic review (PRESPORO #: CRD42020134068) of five databases, supplemented by reference list screening and citation tracking of included papers. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of ‘personality disorder’ in community mental health settings published between before 18 September 2019. Study quality was assessed using the CHEERS statement. Narrative synthesis was used to summarise study findings.ResultsEighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified which evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified.ConclusionThere is no robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs. The review identified the strongest evidence for Dialectical Behavioural Therapy with all three identified studies indicating the intervention is likely to be cost-effective in community settings compared to treatment as usual. Further research is needed to provide robust evidence on the cost-effectiveness of community-based interventions upon which decision makers can confidently base guidelines or allocate resources.

An Economic Evaluation of a Community-Based Organization Led HIV Self-Testing Program Among Men Who Have Sex With Men in China

2020 ◽  
Author(s):  
Shanzi Huang ◽  
Jason Ong ◽  
Wencan Dai ◽  
Xi He ◽  
Yi Zhou ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Testing ◽  
Variable Cost ◽  
Community Based ◽  
Self Testing ◽  
Hiv Test ◽  
Community Based Organization ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

Abstract Introduction: HIV self-testing (HIVST) is effective in improving the uptake of HIV testing among key populations. Complementary data on the cost-effectiveness of HIVST is critical for planning and scaling up HIVST. This study aimed to evaluate the cost-effectiveness of a community-based organization (CBO)-led HIVST model implemented in China. Method: A cost-effectiveness analysis (CEA) was conducted by comparing a CBO-led HIVST model with a CBO-led facility-based HIV rapid diagnostics testing (HIV-RDT) model. The full economic cost, including fixed and variable cost, from a health provider perspective using a micro costing approach was estimated. We determined the cost-effectiveness of these two HIV testing models over a two year time horizon (i.e. duration of the programs), and reported costs using US dollars (2020). Results: From January 2017 to December 2018, a total of 4,633 men tested in the HIVST model, and 1,780 men tested in the HIV-RDT model. The total number of new diagnosis was 155 for HIVST and 126 for the HIV-RDT model; the HIV test positivity was 3.3% (95% confidence interval (CI): 2.8-3.9) for the HIVST model and 7.1% (95% CI: 5.9-8.4) for the HIV-RDT model. The mean cost per person tested was $14.57 for HIVST and $24.74 for HIV-RDT. However, the mean cost per diagnosed was higher for HIVST ($435.52) compared with $349.44 for HIV-RDT.Conclusion: Our study confirms that compared to facility-based HIV-RDT, a community-based organization led HIVST program could have a cheaper mean cost per MSM tested for HIV in China. Better targeting of high-risk individuals would further improve the cost-effectiveness of HIVST.

scholarly journals The Cost-effectiveness of Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis and HIV Testing Strategies in High-risk Groups in India

2019 ◽  
Vol 70 (4) ◽  
pp. 633-642 ◽  
Author(s):  
Pooyan Kazemian ◽  
Sydney Costantini ◽  
Nagalingeswaran Kumarasamy ◽  
A David Paltiel ◽  
Kenneth H Mayer ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Testing ◽  
Scale Up ◽  
Cost Effective ◽  
Status Quo ◽  
Hiv Incidence ◽  
Testing Strategies ◽  
Preexposure Prophylaxis ◽  
Immunodeficiency Virus ◽  
The Cost

Abstract Background The human immunodeficiency virus (HIV) epidemic in India is concentrated among 3.1 million men who have sex with men (MSM) and 1.1 million people who inject drugs (PWID), with a mean incidence of 0.9–1.4 per 100 person-years. We examined the cost-effectiveness of both preexposure prophylaxis (PrEP) and HIV testing strategies for MSM and PWID in India. Methods We populated an HIV microsimulation model with India-specific data and projected clinical and economic outcomes of 7 strategies for MSM/PWID, including status quo; a 1-time HIV test; routine HIV testing every 3, 6, or 12 months; and PrEP with HIV testing every 3 or 6 months. We used a willingness-to-pay threshold of US$1950, the 2017 Indian per capita gross domestic product, to define cost-effectiveness. Results HIV testing alone increased life expectancy by 0.07–0.30 years in MSM; PrEP added approximately 0.90 life-years to status quo. Results were similar in PWID. PrEP with 6-month testing was cost-effective for both MSM (incremental cost-effectiveness ratio [ICER], $1000/year of life saved [YLS]) and PWID (ICER, $500/YLS). Results were most sensitive to HIV incidence. PrEP with 6-month testing would increase HIV-related expenditures by US$708 million (MSM) and US$218 million (PWID) over 5 years compared to status quo. Conclusions While the World Health Organization recommends PrEP with quarterly HIV testing, our analysis identifies PrEP with semiannual testing as the cost-effective HIV prevention strategy for Indian MSM and PWID. Since nationwide scale-up would require a substantial fiscal investment, areas of highest HIV incidence may be the appropriate initial targets for PrEP scale-up.

scholarly journals Scaling-Up NCD Interventions in South-East Asia (SUNI-SEA) - the cost evaluation of life-style related NCD interventions

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Koot
Keyword(s):  
Scaling Up ◽  
Decision Makers ◽  
Cost Evaluation ◽  
Health Coverage ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Gains ◽  
The Cost ◽  
Universal Health

Abstract Vietnam, Myanmar, and Indonesia are trying to create innovative synergies within and between sectors to prevent and treat NCDs. Universal Health Coverage (UHC) is the objective of these countries. The challenge for decision makers in healthcare is to implement programmes and interventions that effectively contain NCDs at the lowest possible cost both in community-based and primary care facilities. The value of implementation and upscaling is assessed by estimating costs, savings and health gains. The presentation focuses on cost-effectiveness evaluation of the entire scaling-up, allowing for comparison within and among countries and generate recommendations for achieving UHC in low- and middle-income countries.

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