scholarly journals Reassessing the Cost-Effectiveness of High-Provitamin A Bananas to Reduce Vitamin A Deficiency in Uganda

2021 ◽  
Vol 5 ◽  
Author(s):  
Marta Kozicka ◽  
Julia Elsey ◽  
Beatrice Ekesa ◽  
Susan Ajambo ◽  
Enoch Kikulwe ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Vitamin A Deficiency ◽  
Cost Effective ◽  
Provitamin A ◽  
Disability Adjusted Life ◽  
Alternative Scenarios ◽  
And Shifts ◽  
The Cost ◽  
Disability Adjusted Life Year ◽  
Promotion Campaigns

There are two high-provitamin A (pVA) banana-based interventions potentially available in Uganda—biofortified genetically modified (GM) banana and fast-tracked banana landraces from outside Uganda that are naturally high in provitamin A (nHpVA). Based on the newest country statistics and using adoption scenarios obtained through focus group discussions and expert interviews, we assess obstacles and opportunities for adoption as well as cost-effectiveness of these interventions. In two alternative scenarios for the GM banana (M9 matooke), we assume 40% and 64% adoption rates, which would result in US$29,374,151 and US$63,259,415 in income saved, respectively. As an alternative, for the symmetrical scenarios, we calculate that if the nHpVA banana (Apantu plantain, native of Ghana) were to be adopted, US$46,100,148 and US$76,364,988 in income would be saved. Taking into account the full cost of R&D, we estimate that the M9 matooke could save one disability-adjusted life year (DALY) at a cost of US$67.37 at best and US$145.09 at worst. We estimate that the Apantu plantain could save one DALY at a cost of US$50.54 at best and US$83.72 at worst. Our DALY analysis estimates that all assessed HpVA banana interventions are extremely cost-effective in all scenarios, following both the World Bank's and the WHO criteria. Nevertheless, successful interventions would require extensive promotion campaigns and shifts in agricultural value chains.

scholarly journals The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242170
Author(s):  
Stephanie Bogdewic ◽  
Rohit Ramaswamy ◽  
David M. Goodman ◽  
Emmanuel K. Srofenyoh ◽  
Sebnem Ucer ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Neonatal Mortality ◽  
Clinical Skills ◽  
Cost Effective ◽  
Regional Hospital ◽  
Sensitivity Analyses ◽  
Neonatal Deaths ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Disability Adjusted Life Year

Objective To evaluate the cost-effectiveness of a program intended to reduce intrapartum and neonatal mortality in Accra, Ghana. Design Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. Methods A program integrating leadership development, clinical skills and quality improvement training was piloted at the Greater Accra Regional Hospital from 2013 to 2016. The number of intrapartum and neonatal deaths prevented were estimated using the hospital’s 2012 stillbirth and neonatal mortality rates as a steady-state assumption. The cost-effectiveness of the intervention was calculated as cost per disability-adjusted life year (DALY) averted. In order to test the assumptions included in this analysis, it was subjected to probabilistic and one-way sensitivity analyses. Main outcome measures Incremental cost-effectiveness ratio (ICER), which measures the cost per disability-adjusted life-year averted by the intervention compared to status quo. Results From 2012 to 2016, there were 45,495 births at the Greater Accra Regional Hospital, of whom 5,734 were admitted to the newborn intensive care unit. The budget for the systems strengthening program was US $1,716,976. Based on program estimates, 307 (±82) neonatal deaths and 84 (±35) stillbirths were prevented, amounting to 12,342 DALYs averted. The systems strengthening intervention was found to be highly cost effective with an ICER of US $139 (±$44), an amount significantly lower than the established threshold of cost-effectiveness of the per capita gross domestic product, which averaged US $1,649 between 2012–2016. The results were found to be sensitive to the following parameters: DALYs averted, number of neonatal deaths, and number of stillbirths. Conclusion An integrated approach to system strengthening in referral hospitals has the potential to reduce neonatal and intrapartum mortality in low resource settings and is likely to be cost-effective. Sustained change can be achieved by building organizational capacity through leadership and clinical training.

Cost-Effectiveness of Cognitive–Behavioural Therapy and Drug Interventions for Major Depression

2005 ◽  
Vol 39 (8) ◽  
pp. 683-692 ◽  
Author(s):  
Theo Vos ◽  
Justine Corry ◽  
Michelle M. Haby ◽  
Rob Carter ◽  
Gavin Andrews
Keyword(s):  
Cost Effectiveness ◽  
Major Depression ◽  
Maintenance Treatment ◽  
Treatment Options ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Disability Adjusted Life Year

Objective: Antidepressant drugs and cognitive–behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness – Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression. Method: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods. Results: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below $A10 000 per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from $A17 000 to $A20 000 per DALY) but still well below $A50 000, which is considered the affordable threshold. Conclusions: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.

scholarly journals Hospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitals

2021 ◽  
Vol 15 (1) ◽  
pp. e0008977
Author(s):  
Lorren Alumasa ◽  
Lian F. Thomas ◽  
Fredrick Amanya ◽  
Samuel M. Njoroge ◽  
Ignacio Moriyón ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
National Level ◽  
Cost Effective ◽  
Human Brucellosis ◽  
Serum Samples ◽  
Therapy Regimen ◽  
Treatment Regimens ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Disability Adjusted Life Year

Hospitals in Kenya continue to use the Febrile Antigen Brucella Agglutination Test (FBAT) to diagnose brucellosis, despite reports showing its inadequacy. This study generated hospital-based evidence on the performance and cost-effectiveness of the FBAT, compared to the Rose Bengal Test (RBT).Twelve hospitals in western Kenya stored patient serum samples that were tested for brucellosis using the FBAT, and these were later re-tested using the RBT. Data on the running time and cost of the FBAT, and the treatment prescribed for brucellosis, were collected. The cost-effectiveness of the two tests, defined as the cost in US Dollars ($) per Disability Adjusted Life Year (DALY) averted, was determined, and a basic sensitivity analysis was run to identify the most influential parameters. Over a 6-month period, 180 patient serum samples that were tested with FBAT at the hospitals were later re-tested with RBT at the field laboratory. Of these 24 (13.3%) and 3 (1.7%) tested positive with FBAT and RBT, respectively. The agreement between the FBAT and RBT was slight (Kappa = 0.12). Treatment prescribed following FBAT positivity varied between hospitals, and only one hospital prescribed a standardized therapy regimen. The mean $/DALY averted when using the FBAT and RBT were $2,065 (95% CI $481-$6,736) and $304 (95% CI $126-$604), respectively. Brucellosis prevalence was the most influential parameter in the cost-effectiveness of both tests. Extrapolation to the national level suggested that an estimated $338,891 (95% CI $47,000-$1,149,000) per year is currently spent unnecessarily treating those falsely testing positive by FBAT. These findings highlight the potential for misdiagnosis using the FBAT. Furthermore, the RBT is cost-effective, and could be considered as the mainstay screening test for human brucellosis in this setting. Lastly, the treatment regimens must be harmonized to ensure the appropriate use of antibiotics for treatment.

scholarly journals Cost Effectiveness Analysis Using Disability-Adjusted Life Years for Cataract Surgery

2020 ◽  
Vol 17 (16) ◽  
pp. 6010
Author(s):  
Thinni Nurul Rochmah ◽  
Anggun Wulandari ◽  
Maznah Dahlui ◽  
Ernawaty ◽  
Ratna Dwi Wulandari
Keyword(s):  
Cost Effectiveness ◽  
Cataract Surgery ◽  
Cost Effective ◽  
Disability Adjusted Life Years ◽  
Cost Effectiveness Ratio ◽  
Small Incision Cataract Surgery ◽  
Post Surgery ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The Cost

Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.

scholarly journals The merits of sustaining pneumococcal vaccination after transitioning from Gavi support – a modelling and cost-effectiveness study for Kenya

2018 ◽  
Author(s):  
John Ojal ◽  
Ulla Griffiths ◽  
Laura L. Hammitt ◽  
Ifedayo Adetifa ◽  
Donald Akech ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Low Income ◽  
Disease Incidence ◽  
Pneumococcal Vaccination ◽  
Cost Effective ◽  
Low Income Countries ◽  
Pneumococcal Carriage ◽  
Disability Adjusted Life ◽  
Disability Adjusted Life Year

AbstractIntroductionMany low income countries soon will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full costs as they transition from Gavi support. Using Kenya as a case study we assessed the incremental cost-effectiveness of continuing PCV use.MethodsWe fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya, and predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya’s transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted-life-year (DALY) averted and associated prediction intervals (PI).ResultsWe predicted that overall IPD incidence will increase by 93% (PI: 72% - 114%) from 8.5 in 2022 to 16.2 per 100,000 per year in 2032, if PCV use is discontinued. Continuing vaccination would prevent 15,355 (PI: 10,196–21,125) deaths and 112,050 (PI: 79,620– 130,981) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15.6 million annually compared to discontinuing vaccination. The incremental cost per DALY averted of continuing PCV was predicted at $142 (PI: 85 - 252) in 2032.ConclusionContinuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective. These arguments support an expansion of the vaccine budget, however, affordability may be a concern.FundingFunded by the Wellcome Trust.

scholarly journals Cost-Effectiveness of Three Poliovirus Immunization Schedules in Shanghai, China

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1062
Author(s):  
Jia Ren ◽  
Hairenguli Maimaiti ◽  
Xiaodong Sun ◽  
Zhuoying Huang ◽  
Jiechen Liu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Polio Eradication ◽  
Paralytic Poliomyelitis ◽  
Tree Model ◽  
Monetary Benefit ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Polio Immunization ◽  
The Cost

In Shanghai, China, a polio immunization schedule of four inactivated polio vaccines (IPV) has been implemented since 2020, replacing the schedules of a combination of two IPVs and two bivalent live attenuated oral polio vaccines (bOPV), and four trivalent live attenuated oral polio vaccines (tOPV). This study aimed to assess the cost-effectiveness of these three schedules in infants born in 2016, in preventing vaccine-associated paralytic poliomyelitis (VAPP). We performed a decision tree model and estimated incremental cost-effectiveness ratio (ICER). Compared to the four-tOPV schedule, the two-IPV-two-bOPV schedule averted 1.2 VAPP cases and 16.83 disability-adjusted life years (DALY) annually; while the four-IPV schedule averted 1.35 VAPP cases and 18.96 DALY annually. Consequently, ICERVAPP and ICERDALY were substantially high for two-IPV-two-bOPV (CNY 12.96 million and 0.93 million), and four-IPV (CNY 21.24 million and 1.52 million). Moreover, net monetary benefit of the two-IPV-two-bOPV and four-IPV schedules was highest when the cost of IPV was hypothesized to be less than CNY 23.75 or CNY 9.11, respectively, and willingness-to-pay was hypothesized as CNY 0.6 million in averting one VAPP-induced DALY. IPV-containing schedules are currently cost-ineffective in Shanghai. They may be cost-effective by reducing the prices of IPV, which may accelerate polio eradication in Chinese settings.

scholarly journals Cost-effectiveness of reflex laboratory-based cryptococcal antigen screening for the prevention and treatment of cryptococcal meningitis in Botswana

2020 ◽  
Vol 4 ◽  
pp. 144
Author(s):  
Mark W. Tenforde ◽  
Charles Muthoga ◽  
Andrew Callaghan ◽  
Ponego Ponatshego ◽  
Julia Ngidi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cryptococcal Meningitis ◽  
Cost Effective ◽  
Decision Analytic Model ◽  
Cryptococcal Antigen ◽  
Prior Art ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Cd4 Testing ◽  
Hiv Aids

Background: Cryptococcal antigen (CrAg) screening for antiretroviral therapy (ART)-naïve adults with advanced HIV/AIDS can reduce the incidence of cryptococcal meningitis (CM) and all-cause mortality. We modeled the cost-effectiveness of laboratory-based “reflex” CrAg screening for ART-naïve CrAg-positive patients with CD4<100 cells/µL (those currently targeted in guidelines) and ART-experienced CrAg-positive patients with CD4<100 cells/µL (who make up an increasingly large proportion of individuals with advanced HIV/AIDS). Methods: A decision analytic model was developed to evaluate CrAg screening and treatment based on local CD4 count and CrAg prevalence data, and realistic assumptions regarding programmatic implementation of the CrAg screening intervention. We modeled the number of CrAg tests performed, the number of CrAg positives stratified by prior ART experience, the proportion of patients started on pre-emptive antifungal treatment, and the number of incident CM cases and CM-related deaths. Screening and treatment costs were evaluated, and cost per death or disability-adjusted life year (DALY) averted estimated. Results: We estimated that of 650,000 samples undergoing CD4 testing annually in Botswana, 16,364 would have a CD4<100 cells/µL and receive a CrAg test, with 70% of patients ART-experienced at the time of screening. Under base model assumptions, CrAg screening and pre-emptive treatment restricted to ART-naïve patients with a CD4<100 cells/µL prevented 20% (39/196) of CM-related deaths in patients undergoing CD4 testing at a cost of US$2 per DALY averted. Expansion of preemptive treatment to include ART-experienced patients with a CD4<100 cells/µL resulted in 55 additional deaths averted (a total of 48% [94/196]) and was cost-saving compared to no screening. Findings were robust across a range of model assumptions. Conclusions: Reflex laboratory-based CrAg screening for patients with CD4<100 cells/µL is a cost-effective strategy in Botswana, even in the context of a relatively low proportion of advanced HIV/AIDS in the overall HIV-infected population, the majority of whom are ART-experienced.

scholarly journals Reducing micronutrient deficiencies in Pakistani children: are subsidies on fortified complementary foods cost-effective?

2018 ◽  
Vol 21 (15) ◽  
pp. 2893-2906 ◽  
Author(s):  
Simon Wieser ◽  
Beatrice Brunner ◽  
Christina Tzogiou ◽  
Rafael Plessow ◽  
Michael B Zimmermann ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Iron Deficiency ◽  
Vitamin A ◽  
Iodine Deficiency ◽  
Iron Deficiency Anaemia ◽  
Vitamin A Deficiency ◽  
Cost Effective ◽  
Micronutrient Deficiencies ◽  
Deficiency Anaemia ◽  
The Cost

AbstractObjectiveTo estimate the cost-effectiveness of price subsidies on fortified packaged complementary foods (FPCF) in reducing iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in Pakistani children.DesignThe study proceeded in three steps: (i) we determined the current lifetime costs of the three micronutrient deficiencies with a health economic model; (ii) we assessed the price sensitivity of demand for FPCF with a market survey in two Pakistani districts; (iii) we combined the findings of the first two steps with the results of a systematic review on the effectiveness of FPCF in reducing micronutrient deficiencies. The cost-effectiveness was estimated by comparing the net social cost of price subsidies with the disability-adjusted life years (DALY) averted.SettingDistricts of Faisalabad and Hyderabad in Pakistan.SubjectsHouseholds with 6–23-month-old children stratified by socio-economic strata.ResultsThe lifetime social costs of iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in 6–23-month-old children amounted to production losses of $US 209 million and 175 000 DALY. Poor households incurred the highest costs, yet even wealthier households suffered substantial losses. Wealthier households were more likely to buy FPCF. The net cost per DALY of the interventions ranged from a return per DALY averted of $US 783 to $US 65. Interventions targeted at poorer households were most cost-effective.ConclusionsPrice subsidies on FPCF might be a cost-effective way to reduce the societal costs of micronutrient deficiencies in 6–23-month-old children in Pakistan. Interventions targeting poorer households are especially cost-effective.

scholarly journals Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018

2020 ◽  
Vol 38 (10) ◽  
pp. 1135-1145 ◽  
Author(s):  
David D. Kim ◽  
Madison C. Silver ◽  
Natalia Kunst ◽  
Joshua T. Cohen ◽  
Daniel A. Ollendorf ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Productivity Loss ◽  
Quality Adjusted Life Year ◽  
Healthcare Sector ◽  
Disability Adjusted Life ◽  
Payer Perspective ◽  
The Cost ◽  
Disability Adjusted Life Year ◽  
The Impact

Abstract Objective Our objective was to examine perspective and costing approaches used in cost-effectiveness analyses (CEAs) and the distribution of reported incremental cost-effectiveness ratios (ICERs). Methods We analyzed the Tufts Medical Center’s CEA and Global Health CEA registries, containing 6907 cost-per-quality-adjusted-life-year (QALY) and 698 cost-per-disability-adjusted-life-year (DALY) studies published through 2018. We examined how often published CEAs included non-health consequences and their impact on ICERs. We also reviewed 45 country-specific guidelines to examine recommended analytic perspectives. Results Study authors often mis-specified or did not clearly state the perspective used. After re-classification by registry reviewers, a healthcare sector or payer perspective was most prevalent (74%). CEAs rarely included unrelated medical costs and impacts on non-healthcare sectors. The most common non-health consequence included was productivity loss in the cost-per-QALY studies (12%) and patient transportation in the cost-per-DALY studies (21%). Of 19,946 cost-per-QALY ratios, the median ICER was $US26,000/QALY (interquartile range [IQR] 2900–110,000), and 18% were cost saving and QALY increasing. Of 5572 cost-per-DALY ratios, the median ICER was $US430/DALY (IQR 67–3400), and 8% were cost saving and DALY averting. Based on 16 cost-per-QALY studies (2017–2018) reporting 68 ICERs from both the healthcare sector and societal perspectives, the median ICER from a societal perspective ($US22,710/QALY [IQR 11,991–49,603]) was more favorable than from a healthcare sector perspective ($US30,402/QALY [IQR 10,486–77,179]). Most governmental guidelines (67%) recommended either a healthcare sector or a payer perspective. Conclusion Researchers should justify and be transparent about their choice of perspective and costing approaches. The use of the impact inventory and reporting of disaggregate outcomes can reduce inconsistencies and confusion.

Measuring and valuing health: an international perspective

2016 ◽  
Author(s):  
John Brazier ◽  
Julie Ratcliffe ◽  
Joshua A. Salomon ◽  
Aki Tsuchiya
Keyword(s):  
Developing Countries ◽  
Cost Effectiveness ◽  
International Perspective ◽  
General Observation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Disability Adjusted Life ◽  
Key Issues ◽  
The Cost ◽  
Disability Adjusted Life Year

The institutionalized demand for cost-effectiveness evidence in low- and middle-income countries—where this sort of information is arguably even more urgently required—has yet to gain traction to the same extent that it has in various countries in the industrialized world. There are several important exceptions to this general observation, and these may signal a rising interest in undertaking and applying cost-effectiveness analysis (CEAs) in developing countries. The disability-adjusted life year (DALY) is an alternative to the QALY that has been favoured in much of the cost-effectiveness work in developing countries; and extends the discussions of key issues in the definition, description, and valuation of health to address some of the added considerations demanded by cross-cultural applications of the methods and tools that are the focus of this book.

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