scholarly journals Cost–Utility Analysis of Wide-Field Imaging as an Auxiliary Technology for Retinopathy of Prematurity Care in Brazil

2021 ◽  
Vol 9 ◽  
Author(s):  
Luiza M Neves ◽  
Lorena M Haefeli ◽  
Andrea A Zin ◽  
Ricardo E Steffen ◽  
Zilton F. M Vasconcelos ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Incremental Cost ◽  
Cost Effective ◽  
Screening Strategy ◽  
Cost Utility ◽  
Wide Field ◽  
Middle Income ◽  
Middle Income Countries ◽  
Screening Coverage ◽  
Rop Screening

Purpose: To evaluate the cost–utility of wide-field imaging (WFI) as a complementary technology for retinopathy of prematurity (ROP) screening from the Brazilian Unified Health System's perspective.Introduction: ROP is one of the leading causes of avoidable childhood blindness worldwide, especially in middle-income countries. The current ROP screening involves indirect binocular ophthalmoscopy (IBO) by ROP expert ophthalmologists. However, there is still insufficient ROP screening coverage. An alternative screening strategy is the combination of WFI with IBO.Methods: A cost–utility analysis was performed using a deterministic decision-tree simulation model to estimate incremental cost–utility for ROP care. Two screening strategies were compared: (1) IBO and (2) combination of WFI of all eligible preterm infants and IBO for type 2 ROP or worse and for non-readable images. Eligible population included preterm infants <32 weeks of gestational age or birth weight equal to or <1,500 g. The temporal horizon was lifetime. Visual outcome data was converted to utility, and the health benefits were estimated on quality-adjusted life-years (QALY). Incremental cost per QALY gained was calculated from the health system perspective. Costs were estimated considering equipment, maintenance, consumables, and staff. A micro-costing approach was used for WFI. Two technician nurses were trained for imaging execution and had their time evaluated. Two ROP expert ophthalmologists had their time evaluated for imaging reading. One-way sensitivity analysis and probabilistic sensitivity analysis were performed.Results: Combined screening strategy resulted in a cost-effective program considering 90% ROP screening coverage. Costs per examination: (1) screening with IBO: US dollar (US $) 34.36; (2) screening with combination: US $58.20; (3) laser treatment: US $642.09; (4) long-term follow-up: ranged from US $69.33 to 286.91, based on the infant's visual function. Incremental cost per QALY gained was US $1,746.99/QALY per infant screened with the combination strategy. One-way sensitivity analysis resulted in cost-effectiveness for all parameters. Probabilistic sensitivity analyses yielded a 100% probability of combination being cost-effective in a willingness-to-pay threshold of US $1,800/QALY.Conclusion: The combined strategy for ROP screening was cost-effective. It enhances access for appropriate ROP care in middle-income countries and dminishes opportunity costs for ophthalmologists.

Cost-Utility of Sildenafil for Persistent Pulmonary Hypertension of the Newborn

2020 ◽  
Author(s):  
Patrick D. Evers ◽  
Paul J. Critser ◽  
Michelle Cash ◽  
Melissa Magness ◽  
Susan Hoelle ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cost Effectiveness ◽  
Relative Risk ◽  
Cost Effective ◽  
Cost Utility ◽  
Persistent Pulmonary Hypertension ◽  
Middle Income ◽  
Middle Income Countries ◽  
Wide Range ◽  
The Impact

Objective While advanced therapies for severe persistent pulmonary hypertension of the newborn (PPHN) such as inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation (ECMO) are standard treatments in high-income countries, these therapies are often unavailable in resource-limited settings such as middle-income countries. However, there are small clinical trials illustrating the efficacy of sildenafil at reducing mortality in PPHN. This analysis sought to determine the cost-utility of enteral sildenafil for the treatment of severe PPHN. Study Design A Markov-state transition model was constructed for the two clinical approaches to compare costs, clinical outcomes, and quality of life: (1) “conventional,” (2) “sildenafil.” The impact of sildenafil was modeled as a relative risk modifier of the conventional strategy's mortality risk. Transitional probabilities, costs, and utility metrics were extracted from the literature. Sensitivity analyses for each model input as well as 100-patient Monte Carlo simulations were used to test the durability of the model conclusion. Results The sildenafil strategy was cost-effective for upper but not lower middle-income countries with an incremental cost-effectiveness ratio of $2,339 per quality-adjusted life year. This conclusion was durable across a wide-range of model assumptions; the sildenafil strategy only failed to meet criteria for cost-effectiveness when sildenafil therapy had a mortality relative risk efficacy of >0.89, if life expectancy in that country is <40 years, or if the lifetime forecasted costs of a survivor's life was quite high. Conclusion Enteral sildenafil is a cost-effective intervention for severe PPHN for upper middle-income countries where ECMO and iNO are not available. Key Points

Cost-effectiveness of upper extremity dry needling in the rehabilitation of patients with stroke

2021 ◽  
pp. 096452842110557
Author(s):  
Daniel Fernández Sanchis ◽  
Juan Nicolás Cuenca Zaldívar ◽  
Sandra Calvo ◽  
Pablo Herrero ◽  
Manuel Gómez Barrera
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Upper Extremity ◽  
Economic Value ◽  
Cost Effective ◽  
Cost Utility ◽  
Dry Needling ◽  
Levels Of Care ◽  
Life Years

Introduction: Dry needling (DN) has been shown to be effective for the treatment of upper extremity hypertonia in patients with stroke. Purpose: To evaluate the cost-effectiveness of DN in patients with stroke. Methods: A cost-effectiveness analysis was performed in a research study conducted at a Spanish public hospital where patients were classified into two groups with or without DN. Hypertonia was measured using the Modified Modified Ashworth Scale (MMAS), and quality of life (QOL) was assessed using the EuroQoL 5-dimension questionnaire. Data regarding the effects and costs of physiotherapy were presented by calculating the mean and 95% confidence interval. The health outcomes were evaluated considering the rate of responders to the treatment based on the MMAS. Spanish preference weights were used to estimate quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were calculated to determine the economic value of DN. Results: Eighty patients with stroke in the subacute stage of recovery were selected to participate in this study. Based on the rate of responders, the ICER of the DN group was very low. Despite the sensitivity analysis performed, the results of the ICUR were not encouraging. Discussion: Cost-effectiveness with responder rate results were favourable for the DN group and were confirmed by the sensitivity analysis according to levels of care. In addition, our findings revealed that 4 weeks of treatment could be more cost-effective than 8 weeks. DN treatment of the upper extremity appears to be cost-effective based on the rate of responders measured using the MMAS scale.

scholarly journals Achieving Viral Suppression in 90% of People Living With Human Immunodeficiency Virus on Antiretroviral Therapy in Low- and Middle-Income Countries: Progress, Challenges, and Opportunities

2018 ◽  
Vol 66 (10) ◽  
pp. 1487-1491 ◽  
Author(s):  
Jean B Nachega ◽  
Nadia A Sam-Agudu ◽  
Lynne M Mofenson ◽  
Mauro Schechter ◽  
John W Mellors
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Suppression ◽  
Cost Effective ◽  
Term Treatment ◽  
Middle Income ◽  
Middle Income Countries ◽  
Long Term Treatment ◽  
Wide Range ◽  
Immunodeficiency Virus ◽  
Low And Middle Income

Abstract Although significant progress has been made, the latest data from low- and middle-income countries show substantial gaps in reaching the third “90%” (viral suppression) of the UNAIDS 90-90-90 goals, especially among vulnerable and key populations. This article discusses critical gaps and promising, evidence-based solutions. There is no simple and/or single approach to achieve the last 90%. This will require multifaceted, scalable strategies that engage people living with human immunodeficiency virus, motivate long-term treatment adherence, and are community-entrenched and ‑supported, cost-effective, and tailored to a wide range of global communities.

Cost-effectiveness of dual-mobility components in patients with displaced femoral neck fractures

2021 ◽  
Vol 103-B (12) ◽  
pp. 1783-1790
Author(s):  
Spencer Montgomery ◽  
Jonathan Bourget-Murray ◽  
Daniel Z. You ◽  
Leo Nherera ◽  
Amir Khoshbin ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Femoral Neck ◽  
Incremental Cost ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effective ◽  
Physiological Age ◽  
Base Case ◽  
Dual Mobility ◽  
Displaced Femoral Neck Fractures

Aims Total hip arthroplasty (THA) with dual-mobility components (DM-THA) has been shown to decrease the risk of dislocation in the setting of a displaced neck of femur fracture compared to conventional single-bearing THA (SB-THA). This study assesses if the clinical benefit of a reduced dislocation rate can justify the incremental cost increase of DM-THA compared to SB-THA. Methods Costs and benefits were established for patients aged 75 to 79 years over a five-year time period in the base case from the Canadian Health Payer’s perspective. One-way and probabilistic sensitivity analysis assessed the robustness of the base case model conclusions. Results DM-THA was found to be cost-effective, with an estimated incremental cost-effectiveness ratio (ICER) of CAD $46,556 (£27,074) per quality-adjusted life year (QALY). Sensitivity analysis revealed DM-THA was not cost-effective across all age groups in the first two years. DM-THA becomes cost-effective for those aged under 80 years at time periods from five to 15 years, but was not cost-effective for those aged 80 years and over at any timepoint. To be cost-effective at ten years in the base case, DM-THA must reduce the risk of dislocation compared to SB-THA by at least 62%. Probabilistic sensitivity analysis showed DM-THA was 58% likely to be cost-effective in the base case. Conclusion Treating patients with a displaced femoral neck fracture using DM-THA components may be cost-effective compared to SB-THA in patients aged under 80 years. However, future research will help determine if the modelled rates of adverse events hold true. Surgeons should continue to use clinical judgement and consider individual patients’ physiological age and risk factors for dislocation. Cite this article: Bone Joint J 2021;103-B(12):1783–1790.

scholarly journals School vision screening programmes in reducing uncorrected refractive error among children in Low and Middle-Income countries-LMIC (systematic review)

2020 ◽  
Vol 10 (4) ◽  
pp. 91-105
Author(s):  
Abraham Opare ◽  
Leila H Abdullahi ◽  
Deon Minnies ◽  
Colin Cook ◽  
Maylene Shung-King ◽  
...  
Keyword(s):  
Academic Performance ◽  
School Children ◽  
Refractive Error ◽  
Positive Impact ◽  
Cost Effective ◽  
Vision Screening ◽  
Middle Income ◽  
Middle Income Countries ◽  
School Vision ◽  
Uncorrected Refractive Error

ackground: The prevalence of uncorrected refractive error among school-age children is on the rise with detrimental effect on academic performance and socio-economic status of those affected. School vision screening programmes appear to be an effective way of identifying children with uncorrected refractive errors so early intervention can be made. Despite the increasing popularity of school vision screening programmes over the past few years, there is a lot of debate on its effectiveness in reducing the proportion of children with uncorrected refractive error in the long term, especially in settings where resources are limited. Some studies argue that school vision screening programmes are effective while other studies have reported otherwise. The purpose of this systematic review was to assess the effectiveness of school vision screening programmes in reducing uncorrected refractive error among children in low and middle income countries using evidence from published studies. Methods and findings: A comprehensive and systematic strategy was used to search various databases including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) which contains the Cochrane Eyes and vision Trial Register, the Cochrane Library, Medline (1980-2018), CINAHL, Academic Search Premier, Web of Science, the WHO’s Library Information System, Africa-Wide and Scopus. The search was restricted to articles published in English. Randomized control trials, cross-sectional studies, case-control studies and cohort studies were included in this review. Participants included school children with refractive error. Full-text review of search results, data extraction and risk of bias assessment was done by two independent reviewers. The certainty of the evidence was assessed using the GRADE approach and data were pooled using the random-effect model. Thirty studies met the inclusion criteria. This review found moderate certainty evidence indicating that school vision screenings may be effective in reducing uncorrected refractive error among school children by 81% (95% CI: 77%; 84%), 24% (95% CI: 13%; 35%) and 20% (95% CI: 18%; 22%) at two, six, and more than six months respectively after its introduction. Results: Results of this review also suggest that school vision screening may be effective in achieving 54% (95% CI: 25%; 100%), 57% (95% CI: 46%; 70%), 37% (95% CI: 26%; 52%), and 32% (95% CI: 14%; 72%) spectacle-wear compliance among school children at less than three months, at three months, at six months and at more than six months respectively after its introduction (low to moderate certainty evidence). This review further found moderate to high certainty evidence indicating that school vision screening, together with provision of spectacles, may be relatively cost effective, safe and has a positive impact on the academic performance of school children. Conclusion: The findings of this review show that school vision screening, together with provision of spectacles, may be a safe and cost-effective way of reducing the proportion of children with uncorrected refractive error, with long-term positive impact on academic performance of children. Most of the studies included in this review were, however, conducted in Asia. Research to investigate the effectiveness of school vision screening programmes in other parts of the world like Africa where few studies have been conducted is highly recommended

Smoking Cessation Therapy is a Cost-Effective Intervention to Avoid Tooth Loss in Subjects With Periodontitis – An Economic Evaluation 

2021 ◽  
Author(s):  
Maria Luisa Silveira Souto ◽  
Fernanda Campos Almeida Carrer ◽  
Mariana Minatel Braga ◽  
Cláudio Mendes Pannuti
Keyword(s):  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Oral Health ◽  
Incremental Cost ◽  
Tooth Loss ◽  
Cost Effective ◽  
Cost Utility ◽  
Health Related ◽  
Per Oral ◽  
Smoking Cessation Therapy

Abstract Background: Smokers present a higher prevalence and severity of periodontitis and, consequently, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. So, the aim of this study was evaluated the efficiency in resources allocation when implementing smoking cessation therapy vs. its non-implementation in smokers with periodontitis. Methods: We adopted the Brazilian public system perspective to determine the incremental cost-effectiveness (cost per tooth loss avoided) and cost-utility (cost per oral-related quality-adjusted life-year ([QALY] gained) of implementing smoking cessation therapy. Base-case was defined as a 48 years-old male subject and horizon of 30 years. Effects and costs were combined in a decision analytic modeling framework to permit a quantitative approach aiming to estimate the value of the consequences of smoking cessation therapy adjusted for their probability of occurrence. Markov models were carried over annual cycles. Sensitivity analysis tested methodological assumptions. Results: Implementation of smoking cessation therapy had an average incremental cost of U$60.58 per tooth loss avoided and U$4.55 per oral related-QALY gained. Considering uncertainties, the therapy could be cost-effective in the most part of simulated cases, even being cheaper and more effective in 53% of cases in which the oral-health related outcome is used as effect. Considering a willingness-to-pay of US$100 per health effect, smoking cessation therapy was cost-effective, respectively, in 81% and 100% of cases in cost-utility and cost-effectiveness analyses. Conclusions: Implementation of smoking cessation therapy may be cost-effective, considering the avoidance of tooth loss and oral health-related consequences to patients.

E-Government for Health Facilities in Africa

2015 ◽  
pp. 21-27
Author(s):  
Paul Macharia ◽  
Davies Kimanga ◽  
Onesimus Kamau
Keyword(s):  
Information And Communication Technologies ◽  
Clinical Care ◽  
Health Financing ◽  
Cost Effective ◽  
Healthcare Services ◽  
Bring Your Own Device ◽  
Workplace Flexibility ◽  
Middle Income ◽  
Middle Income Countries ◽  
Information And Communication

Low and Middle Income Countries (LMICs) face healthcare worker shortages, skill mix imbalances, and maldistributions; there is concern in their quality and productivity. Africa's infrastructural developments also are way behind the rest of the world, and this gap is widening. Scalable, cost-effective, and long-term strategies in healthcare services are greatly needed. This chapter explores how Information and Communication Technologies (ICTs) could play an important role in improving healthcare. Components of e-health, an emerging field in medicine, clinical care, and public health are discussed. The role of m-health is explored, identifying the benefits of integrating mobile phone technologies in healthcare. To meet the health financing deficiencies, the chapter also explores how Bring-Your-Own-Device (BYOD) could drive healthcare professionals' productivity through increased workplace flexibility.

scholarly journals Immunisation financing and programme performance in the Middle East and North Africa, 2010 to 2017

2019 ◽  
Vol 4 (2) ◽  
pp. e001248
Author(s):  
Helen Saxenian ◽  
Nahad Sadr-Azodi ◽  
Miloud Kaddar ◽  
Kamel Senouci
Keyword(s):  
Economic Growth ◽  
Middle East ◽  
North Africa ◽  
Low Income ◽  
Health Sector ◽  
Cost Effective ◽  
Middle Income ◽  
Middle Income Countries ◽  
Life Saving ◽  
Fiscal Space

Immunisation is a cornerstone to primary health care and is an exceptionally good value. The 14 low-income and middle-income countries in the Middle East and North Africa region make up 88% of the region’s population and 92% of its births. Many of these countries have maintained high immunisation coverage even during periods of low or negative economic growth. However, coverage has sharply deteriorated in countries directly impacted by conflict and political unrest. Approximately 1.3 million children were not completely vaccinated in 2017, as measured by third dose of diphtheria–pertussis–tetanus vaccine. Most of the countries have been slow to adopt the newer, more expensive life-saving vaccines mainly because of financial constraints and the socioeconomic context. Apart from the three countries that have had long-standing assistance from Gavi, the Vaccine Alliance, most countries have not benefited appreciably from donor and partner activities in supporting their health sector and in achieving their national and subnational immunisation targets. Looking forward, development partners will have an important role in helping reconstruct health systems in conflict-affected countries. They can also help with generating evidence and strategic advocacy for high-priority and cost-effective services, including immunisation. Governments and ministries of health would ensure important benefits to their populations by investing further in their immunisation programmes. Where possible, the health system can create and expand fiscal space from efficiency gains in harmonising vaccine procurement mechanisms and service integration; broader revenue generation from economic growth; and reallocation of government budgets to health, and from within health, to immunization.

scholarly journals Antiparasitic phytotherapy perspectives, scope and current development

Infectio ◽  
2019 ◽  
Vol 23 (2) ◽  
pp. 189 ◽  
Author(s):  
Jhon Carlos Castaño Osorio ◽  
Alejandra María Giraldo García
Keyword(s):  
Low Income ◽  
Public Health Problem ◽  
Cost Effective ◽  
Prolonged Treatment ◽  
Major Public Health Problem ◽  
Middle Income ◽  
Middle Income Countries ◽  
Commercial Markets ◽  
Health And Economic Development ◽  
New Treatments

Tropical protozoan diseases are currently a major public health problem throughout the world and are strongly linked with poverty, this combined with a lack of commercial markets for potential drugs has created a large burden on the health and economic development of low-income and middle-income countries in Africa, Asia, and the Americas. Due to the low research interest and the high increase of resistance against the existing treatments, as well as increasing inefficiency, toxicity, prolonged treatment schedules and costs, there is an urgent need for cost-effective, safe and easy-to-administer, new effective compounds with novel mechanisms of action. Several studies of crude plant extracts have already identified potential compounds to treat Chagas’ disease, Leishmaniasis, Toxoplasmosis, Giardiasis, and Malaria among other protozoan parasites. Natural compounds of medicinal plants have shown lower toxicity together with higher specificity, creating an optimistic view of new treatments for diseases. Out of 1010 new active substances approved as drugs for medical conditions by regulatory agencies during the past 25 years, 490(48.5%) were from a natural origin.

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