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Jit M, Hutubessy R. Methodological Challenges to Economic Evaluations of Vaccines: Is a Common Approach Still Possible? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:245-52. [PMID: 26832145 PMCID: PMC4871927 DOI: 10.1007/s40258-016-0224-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Economic evaluation of vaccination is a key tool to inform effective spending on vaccines. However, many evaluations have been criticised for failing to capture features of vaccines which are relevant to decision makers. These include broader societal benefits (such as improved educational achievement, economic growth and political stability), reduced health disparities, medical innovation, reduced hospital beds pressures, greater peace of mind and synergies in economic benefits with non-vaccine interventions. Also, the fiscal implications of vaccination programmes are not always made explicit. Alternative methodological frameworks have been proposed to better capture these benefits. However, any broadening of the methodology for economic evaluation must also involve evaluations of non-vaccine interventions, and hence may not always benefit vaccines given a fixed health-care budget. The scope of an economic evaluation must consider the budget from which vaccines are funded, and the decision-maker's stated aims for that spending to achieve.
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Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 6BT, UK.
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
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Watkins DA, Olson ZD, Verguet S, Nugent RA, Jamison DT. Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis. Health Policy Plan 2016; 31:75-82. [PMID: 25841771 PMCID: PMC4724166 DOI: 10.1093/heapol/czv023] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/13/2022] Open
Abstract
The South African Government recently set targets to reduce cardiovascular disease (CVD) by lowering salt consumption. We conducted an extended cost-effectiveness analysis (ECEA) to model the potential health and economic impacts of this salt policy. We used surveys and epidemiologic studies to estimate reductions in CVD resulting from lower salt intake. We calculated the average out-of-pocket (OOP) cost of CVD care, using facility fee schedules and drug prices. We estimated the reduction in OOP expenditures and government subsidies due to the policy. We estimated public and private sector costs of policy implementation. We estimated financial risk protection (FRP) from the policy as (1) cases of catastrophic health expenditure (CHE) averted or (2) cases of poverty averted. We also performed a sensitivity analysis. We found that the salt policy could reduce CVD deaths by 11%, with similar health gains across income quintiles. The policy could save households US$ 4.06 million (2012) in OOP expenditures (US$ 0.29 per capita) and save the government US$ 51.25 million in healthcare subsidies (US$ 2.52 per capita) each year. The cost to the government would be only US$ 0.01 per capita; hence, the policy would be cost saving. If the private sector food reformulation costs were passed on to consumers, food expenditures would increase by <0.2% across all income quintiles. Preventing CVD could avert 2400 cases of CHE or 2000 cases of poverty yearly. Our results were sensitive to baseline CVD mortality rates and the cost of treatment. We conclude that, in addition to health gains, population salt reduction can have positive economic impacts-substantially reducing OOP expenditures and providing FRP, particularly for the middle class. The policy could also provide large government savings on health care.
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Affiliation(s)
- David A Watkins
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA, Department of Medicine, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa,
| | - Zachary D Olson
- School of Public Health, The University of California, Berkeley, CA, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Rachel A Nugent
- Department of Global Health, University of Washington, Seattle, WA, USA and
| | - Dean T Jamison
- Department of Global Health, University of Washington, Seattle, WA, USA and Global Health Sciences, The University of California, San Francisco, CA, USA
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Diop A, Atherly D, Faye A, Lamine Sall F, Clark AD, Nadiel L, Yade B, Ndiaye M, Fafa Cissé M, Ba M. Estimated impact and cost-effectiveness of rotavirus vaccination in Senegal: A country-led analysis. Vaccine 2016; 33 Suppl 1:A119-25. [PMID: 25919151 DOI: 10.1016/j.vaccine.2014.12.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Rotavirus is the leading cause of acute severe diarrhea among children under 5 globally and one of the leading causes of death attributable to diarrhea. Among African children hospitalized with diarrhea, 38% of the cases are due to rotavirus. In Senegal, rotavirus deaths are estimated to represent 5.4% of all deaths among children under 5. Along with the substantial disease burden, there is a growing awareness of the economic burden created by diarrheal disease. This analysis aims to provide policymakers with more consistent and reliable economic evidence to support the decision-making process about the introduction and maintenance of a rotavirus vaccine program. METHODS The study was conducted using the processes and tools first established by the Pan American Health Organization's ProVac Initiative in the Latin American region. TRIVAC version 2.0, an Excel-based model, was used to perform the analysis. The costs and health outcomes were calculated for 20 successive birth cohorts (2014-2033). Model inputs were gathered from local, national, and international sources with the guidance of a Senegalese group of experts including local pediatricians, personnel from the Ministry of Health and the World Health Organization, as well as disease-surveillance and laboratory specialists. RESULTS The cost per disability-adjusted life-year (DALY) averted, discounted at 3%, is US$ 92 from the health care provider perspective and US$ 73 from the societal perspective. For the 20 cohorts, the vaccine is projected to prevent more than 2 million cases of rotavirus and to avert more than 8500 deaths. The proportion of rotavirus deaths averted is estimated to be 42%. For 20 cohorts, the discounted net costs of the program were estimated to be US$ 17.6 million from the healthcare provider perspective and US$ 13.8 million from the societal perspective. CONCLUSION From both perspectives, introducing the rotavirus vaccine is highly cost-effective compared to no vaccination. The results are consistent with those found in many African countries. The ProVac process and tools contributed to a collaborative, country-led process in Senegal that provides a platform for gathering and reporting evidence for vaccine decision-making.
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Affiliation(s)
- Abdou Diop
- Independent Consultant for PATH, Dakar, Senegal
| | | | | | | | - Andrew D Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Moussa Fafa Cissé
- Albert Royer Children's Hospital, University Cheikh Anta Diop, Dakar, Senegal
| | - Mamadou Ba
- Albert Royer Children's Hospital, University Cheikh Anta Diop, Dakar, Senegal
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Megiddo I, Colson A, Chisholm D, Dua T, Nandi A, Laxminarayan R. Health and economic benefits of public financing of epilepsy treatment in India: An agent-based simulation model. Epilepsia 2016; 57:464-74. [PMID: 26765291 PMCID: PMC5019268 DOI: 10.1111/epi.13294] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE An estimated 6-10 million people in India live with active epilepsy, and less than half are treated. We analyze the health and economic benefits of three scenarios of publicly financed national epilepsy programs that provide: (1) first-line antiepilepsy drugs (AEDs), (2) first- and second-line AEDs, and (3) first- and second-line AEDs and surgery. METHODS We model the prevalence and distribution of epilepsy in India using IndiaSim, an agent-based, simulation model of the Indian population. Agents in the model are disease-free or in one of three disease states: untreated with seizures, treated with seizures, and treated without seizures. Outcome measures include the proportion of the population that has epilepsy and is untreated, disability-adjusted life years (DALYs) averted, and cost per DALY averted. Economic benefit measures estimated include out-of-pocket (OOP) expenditure averted and money-metric value of insurance. RESULTS All three scenarios represent a cost-effective use of resources and would avert 800,000-1 million DALYs per year in India relative to the current scenario. However, especially in poor regions and populations, scenario 1 (which publicly finances only first-line therapy) does not decrease the OOP expenditure or provide financial risk protection if we include care-seeking costs. The OOP expenditure averted increases from scenarios 1 through 3, and the money-metric value of insurance follows a similar trend between scenarios and typically decreases with wealth. In the first 10 years of scenarios 2 and 3, households avert on average over US$80 million per year in medical expenditure. SIGNIFICANCE Expanding and publicly financing epilepsy treatment in India averts substantial disease burden. A universal public finance policy that covers only first-line AEDs may not provide significant financial risk protection. Covering costs for both first- and second-line therapy and other medical costs alleviates the financial burden from epilepsy and is cost-effective across wealth quintiles and in all Indian states.
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Affiliation(s)
- Itamar Megiddo
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.,Department of Management Science, University of Strathclyde, Glasgow, United Kingdom
| | - Abigail Colson
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.,Department of Management Science, University of Strathclyde, Glasgow, United Kingdom.,Princeton Environmental Institute, Princeton University, Princeton, New Jersey, U.S.A
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Arindam Nandi
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.,Public Health Foundation of India, New Delhi, India
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.,Department of Management Science, University of Strathclyde, Glasgow, United Kingdom.,Princeton Environmental Institute, Princeton University, Princeton, New Jersey, U.S.A
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Olson Z, Staples JA, Mock C, Nguyen NP, Bachani AM, Nugent R, Verguet S. Helmet regulation in Vietnam: impact on health, equity and medical impoverishment. Inj Prev 2016; 22:233-8. [PMID: 26728008 PMCID: PMC4975813 DOI: 10.1136/injuryprev-2015-041650] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 11/30/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vietnam's 2007 comprehensive motorcycle helmet policy increased helmet use from about 30% of riders to about 93%. We aimed to simulate the effect that this legislation might have on: (a) road traffic deaths and non-fatal injuries, (b) individuals' direct acute care injury treatment costs, (c) individuals' income losses from missed work and (d) individuals' protection against medical impoverishment. METHODS AND FINDINGS We used published secondary data from the literature to perform a retrospective extended cost-effectiveness analysis simulation study of the policy. Our model indicates that in the year following its introduction a helmet policy employing standard helmets likely prevented approximately 2200 deaths and 29 000 head injuries, saved individuals US$18 million in acute care costs and averted US$31 million in income losses. From a societal perspective, such a comprehensive helmet policy would have saved $11 000 per averted death or $830 per averted non-fatal injury. In terms of financial risk protection, traffic injury is so expensive to treat that any injury averted would necessarily entail a case of catastrophic health expenditure averted. CONCLUSIONS The high costs associated with traffic injury suggest that helmet legislation can decrease the burden of out-of-pocket payments and reduced injuries decrease the need for access to and coverage for treatment, allowing the government and individuals to spend resources elsewhere. These findings suggest that comprehensive motorcycle helmet policies should be adopted by low-income and middle-income countries where motorcycles are pervasive yet helmet use is less common.
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Affiliation(s)
- Zachary Olson
- School of Public Health, University of California, Berkeley, California, USA
| | - John A Staples
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Harborview Injury Prevention and Research Center, Seattle, Washington, USA
| | - Charles Mock
- Harborview Injury Prevention and Research Center, Seattle, Washington, USA Department of Global Health, University of Washington, Seattle, Washington, USA Department of Surgery, University of Washington, Seattle, Washington, USA
| | | | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg, School of Public Health, Baltimore, Maryland, USA
| | - Rachel Nugent
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Shrime MG, Verguet S, Johansson KA, Desalegn D, Jamison DT, Kruk ME. Task-sharing or public finance for the expansion of surgical access in rural Ethiopia: an extended cost-effectiveness analysis. Health Policy Plan 2015; 31:706-16. [PMID: 26719347 DOI: 10.1093/heapol/czv121] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/14/2022] Open
Abstract
Despite a high burden of surgical disease, access to surgical services in low- and middle-income countries is often limited. In line with the World Health Organization's current focus on universal health coverage and equitable access to care, we examined how policies to expand access to surgery in rural Ethiopia would impact health, impoverishment and equity. An extended cost-effectiveness analysis was performed. Deterministic and stochastic models of surgery in rural Ethiopia were constructed, utilizing pooled estimates of costs and probabilities from national surveys and published literature. Model calibration and validation were performed against published estimates, with sensitivity analyses on model assumptions to check for robustness. Outcomes of interest were the number of deaths averted, the number of cases of poverty averted and the number of cases of catastrophic expenditure averted for each policy, divided across wealth quintiles. Health benefits, financial risk protection and equity appear to be in tension in the expansion of access to surgical care in rural Ethiopia. Health benefits from each of the examined policies accrued primarily to the poor. However, without travel vouchers, many policies also induced impoverishment in the poor while providing financial risk protection to the rich, calling into question the equitable distribution of benefits by these policies. Adding travel vouchers removed the impoverishing effects of a policy but decreased the health benefit that could be bought per dollar spent. These results were robust to sensitivity analyses.
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Affiliation(s)
- Mark G Shrime
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA, Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA,
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, Bergen University, Bergen, Norway
| | - Dawit Desalegn
- Department of Obstetrics and Gynaecology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia and
| | - Dean T Jamison
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
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Johansson KA, Memirie ST, Pecenka C, Jamison DT, Verguet S. Health Gains and Financial Protection from Pneumococcal Vaccination and Pneumonia Treatment in Ethiopia: Results from an Extended Cost-Effectiveness Analysis. PLoS One 2015; 10:e0142691. [PMID: 26650078 PMCID: PMC4674114 DOI: 10.1371/journal.pone.0142691] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 10/26/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pneumonia and pneumococcal disease cause a large disease burden in resource-constrained settings. We pursue an extended cost-effectiveness analysis (ECEA) of two fully publicly financed interventions in Ethiopia: pneumococcal vaccination for newborns and pneumonia treatment for under-five children in Ethiopia. METHODS We apply ECEA methods and estimate the program impact on: (1) government program costs; (2) pneumonia and pneumococcal deaths averted; (3) household expenses related to pneumonia/pneumococcal disease treatment averted; (4) prevention of household medical impoverishment measured by an imputed money-metric value of financial risk protection; and (5) distributional consequences across the wealth strata of the country population. Available epidemiological and cost data from Ethiopia are applied and the two interventions are assessed separately at various incremental coverage levels. RESULTS Scaling-up pneumococcal vaccines at around 40% coverage would cost about $11.5 million and avert about 2090 child deaths annually, while a 10% increase of pneumonia treatment to all children under 5 years of age would cost about $13.9 million and avert 2610 deaths annually. Health benefits of the two interventions publicly financed would be concentrated among the bottom income quintile, where 30-40% of all deaths averted would be expected to occur in the poorest quintile. In sum, the two interventions would eliminate a total of $2.4 million of private household expenditures annually, where the richest quintile benefits from around 30% of the total private expenditures averted. The financial risk protection benefits would be largely concentrated among the bottom income quintile. The results are most sensitive to variations in vaccine price, population size, number of deaths due to pneumonia, efficacy of interventions and out-of-pocket copayment share. CONCLUSIONS Vaccine and treatment interventions for children, as shown with the illustrative examples of pneumococcal vaccine and pneumonia treatment, can bring large health and financial benefits to households in Ethiopia, most particularly among the poorest socio-economic groups.
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Affiliation(s)
- Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | | | - Dean T. Jamison
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Prinja S, Chauhan AS, Angell B, Gupta I, Jan S. A Systematic Review of the State of Economic Evaluation for Health Care in India. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:595-613. [PMID: 26449485 DOI: 10.1007/s40258-015-0201-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Economic evaluations are one of the important tools in policy making for rational allocation of resources. Given the very low public investment in the health sector in India, it is critical that resources are used wisely on interventions proven to yield best results. Hence, we undertook this study to assess the extent and quality of evidence for economic evaluation of health-care interventions and programmes in India. METHODS A comprehensive search was conducted to search for published full economic evaluations pertaining to India and addressing a health-related intervention or programme. PubMed, Scopus, Embase, ScienceDirect, and York CRD database and websites of important research agencies were identified to search for economic evaluations published from January 1980 to the middle of November 2014. Two researchers independently assessed the quality of the studies based on Drummond and modelling checklist. RESULTS Out of a total of 5013 articles enlisted after literature search, a total of 104 met the inclusion criteria for this systematic review. The majority of these papers were cost-effectiveness studies (64%), led by a clinician or public-health professional (77%), using decision analysis-based methods (59%), published in an international journal (80%) and addressing communicable diseases (58%). In addition, 42% were funded by an international funding agency or UN/bilateral aid agency, and 30% focussed on pharmaceuticals. The average quality score of these full economic evaluations was 65.1%. The major limitation was the inability to address uncertainties involved in modelling as only about one-third of the studies assessed modelling structural uncertainties (33%), or ran sub-group analyses to account for heterogeneity (36.5%) or analysed methodological uncertainty (32%). CONCLUSION The existing literature on economic evaluations in India is inadequate to feed into sound policy making. There is an urgent need to generate awareness within the government of how economic evaluation can inform and benefit policy making, and at the same time build capacity of health-care professionals in understanding the economic principles of health-care delivery system.
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Affiliation(s)
- Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
| | - Akashdeep Singh Chauhan
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Blake Angell
- The George Institute for Global Health, Camperdown, NSW, 2050, Australia
| | - Indrani Gupta
- Health Policy Research Unit, Institute of Economic Growth, University of Delhi Enclave, Delhi, 110007, India
| | - Stephen Jan
- The George Institute for Global Health, Camperdown, NSW, 2050, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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Jit M, Hutubessy R, Png ME, Sundaram N, Audimulam J, Salim S, Yoong J. The broader economic impact of vaccination: reviewing and appraising the strength of evidence. BMC Med 2015; 13:209. [PMID: 26335923 PMCID: PMC4558933 DOI: 10.1186/s12916-015-0446-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/11/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Microeconomic evaluations of public health programmes such as immunisation typically only consider direct health benefits and medical cost savings. Broader economic benefits around childhood development, household behaviour, and macro-economic indicators are increasingly important, but the evidence linking immunization to such benefits is unclear. METHODS A conceptual framework of pathways between immunisation and its proposed broader economic benefits was developed through expert consultation. Relevant articles were obtained from previous reviews, snowballing, and expert consultation. Articles were associated with one of the pathways and quality assessed using modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. RESULTS We found 20 studies directly relevant to one or more pathways. Evidence of moderate quality from experimental and observational studies was found for benefits due to immunisation in improved childhood physical development, educational outcomes, and equity in distribution of health gains. Only modelling evidence or evidence outside the immunization field supports extrapolating these benefits to household economic behaviour and macro-economic indicators. CONCLUSION Innovative use of experimental and observational study designs is needed to fill evidence gaps around key pathways between immunisation and many of its proposed economic benefits.
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Affiliation(s)
- Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, 27, Switzerland.
| | - May Ee Png
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Neisha Sundaram
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Jananie Audimulam
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Safiyah Salim
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.
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Driessen J, Olson ZD, Jamison DT, Verguet S. Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis. Soc Sci Med 2015; 139:115-22. [DOI: 10.1016/j.socscimed.2015.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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An extended cost-effectiveness analysis of publicly financed HPV vaccination to prevent cervical cancer in China. Vaccine 2015; 33:2830-41. [DOI: 10.1016/j.vaccine.2015.02.052] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 01/31/2023]
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Loganathan T, Lee WS, Lee KF, Jit M, Ng CW. Household catastrophic healthcare expenditure and impoverishment due to rotavirus gastroenteritis requiring hospitalization in Malaysia. PLoS One 2015; 10:e0125878. [PMID: 25941805 PMCID: PMC4420491 DOI: 10.1371/journal.pone.0125878] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/26/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking. OBJECTIVES We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia. METHODS A two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur) and rural (Kuala Terengganu) setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained. RESULTS Of the 658 stool samples collected at both centers, 248 (38%) were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; p<0.001). The mean direct and indirect costs for rotavirus gastroenteritis consisted 20% of monthly household income in Kuala Lumpur, as compared with only 5% in Kuala Terengganu. Direct medical costs paid out-of-pocket caused 141 (33%) households in Kuala Lumpur to experience catastrophic expenditure and 11 (3%) households to incur poverty. However in Kuala Terengganu, only one household (0.5%) experienced catastrophic healthcare expenditure and none were impoverished. The lowest income quintile in Kuala Lumpur was more likely to experience catastrophic payments compared to the highest quintile (87% vs 8%). The concentration index for out-of-pocket healthcare payments was closer to zero at Kuala Lumpur (0.03) than at Kuala Terengganu (0.24). CONCLUSIONS While urban households were wealthier, healthcare expenditure due to gastroenteritis had more catastrophic and poverty impact on the urban poor. Universal rotavirus vaccination would reduce both disease burden and health inequities in Malaysia.
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Affiliation(s)
- Tharani Loganathan
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Way-Seah Lee
- Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
- University Malaya Paediatric and Child Health Research Group, Kuala Lumpur, Malaysia
| | - Kok-Foo Lee
- Paediatric Department, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Mark Jit
- Modeling and Economics Unit, Public Health England, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chiu-Wan Ng
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Pecenka CJ, Johansson KA, Memirie ST, Jamison DT, Verguet S. Health gains and financial risk protection: an extended cost-effectiveness analysis of treatment and prevention of diarrhoea in Ethiopia. BMJ Open 2015; 5:e006402. [PMID: 25941175 PMCID: PMC4420944 DOI: 10.1136/bmjopen-2014-006402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 03/20/2015] [Accepted: 03/25/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Policymakers face many decisions when considering public financing for health, including the kind of health interventions to include in a publically financed package. The consequences of these choices will influence health outcomes as well as the financial risk protection provided to different segments of the population. The purpose of this study is to illustrate the size and distribution of benefits due to treatment and prevention of diarrhoea (ie, rotavirus vaccination). METHODS We use an economic model to examine the impacts of universal public finance (UPF) of diarrhoeal treatment alone, as opposed to diarrhoeal treatment along with rotavirus vaccination in Ethiopia using extended cost-effectiveness analysis (ECEA). ECEA allows us to measure the health gains and financial risk protection provided by these interventions for each wealth quintile. Our model compares a baseline situation with diarrhoeal treatment seeking of 32% (overall) and no rotavirus vaccination, to a situation where UPF increases treatment seeking by 20 percentage points for each quintile and rotavirus vaccination reaches DTP (diphteria, pertussis, tetanus) 2 levels for each quintile (overall rate of 52%). We calculate deaths averted, private expenditures averted and costs incurred by the government under the baseline situation and with UPF. RESULTS We find that diarrhoeal treatment paired with rotavirus vaccination is more cost effective than diarrhoeal treatment alone for the metrics we examine in this paper (deaths and private expenditures averted). Per US$1 million invested, diarrhoeal treatment saves 44 lives and averts US$115,000 in private expenditures. For the same investment, diarrhoeal treatment and rotavirus vaccination save 61 lives and avert US$150,000 in private expenditures. The health benefits of these interventions tend to benefit the poor, while the financial benefits favour the better-off. CONCLUSIONS Policymakers should consider multiple benefit streams as well as their scale and incidence when considering public finance of health interventions.
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Affiliation(s)
| | - Kjell Arne Johansson
- The Department of Global Public Health and Primary Care, The University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- The Department of Global Public Health and Primary Care, The University of Bergen, Bergen, Norway
| | - Dean T Jamison
- Department of Global Health, The University of Washington, Seattle, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, USA
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Verguet S, Olson ZD, Babigumira JB, Desalegn D, Johansson KA, Kruk ME, Levin CE, Nugent RA, Pecenka C, Shrime MG, Memirie ST, Watkins DA, Jamison DT. Health gains and financial risk protection afforded by public financing of selected interventions in Ethiopia: an extended cost-effectiveness analysis. LANCET GLOBAL HEALTH 2015; 3:e288-96. [DOI: 10.1016/s2214-109x(14)70346-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Megiddo I, Colson AR, Nandi A, Chatterjee S, Prinja S, Khera A, Laxminarayan R. Analysis of the Universal Immunization Programme and introduction of a rotavirus vaccine in India with IndiaSim. Vaccine 2015; 32 Suppl 1:A151-61. [PMID: 25091670 DOI: 10.1016/j.vaccine.2014.04.080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES India has the highest under-five death toll globally, approximately 20% of which is attributed to vaccine-preventable diseases. India's Universal Immunization Programme (UIP) is working both to increase immunization coverage and to introduce new vaccines. Here, we analyze the disease and financial burden alleviated across India's population (by wealth quintile, rural or urban area, and state) through increasing vaccination rates and introducing a rotavirus vaccine. METHODS We use IndiaSim, a simulated agent-based model (ABM) of the Indian population (including socio-economic characteristics and immunization status) and the health system to model three interventions. In the first intervention, a rotavirus vaccine is introduced at the current DPT3 immunization coverage level in India. In the second intervention, coverage of three doses of rotavirus and DPT and one dose of the measles vaccine are increased to 90% randomly across the population. In the third, we evaluate an increase in immunization coverage to 90% through targeted increases in rural and urban regions (across all states) that are below that level at baseline. For each intervention, we evaluate the disease and financial burden alleviated, costs incurred, and the cost per disability-adjusted life-year (DALY) averted. RESULTS Baseline immunization coverage is low and has a large variance across population segments and regions. Targeting specific regions can approximately equate the rural and urban immunization rates. Introducing a rotavirus vaccine at the current DPT3 level (intervention one) averts 34.7 (95% uncertainty range [UR], 31.7-37.7) deaths and $215,569 (95% UR, $207,846-$223,292) out-of-pocket (OOP) expenditure per 100,000 under-five children. Increasing all immunization rates to 90% (intervention two) averts an additional 22.1 (95% UR, 18.6-25.7) deaths and $45,914 (95% UR, $37,909-$53,920) OOP expenditure. Scaling up immunization by targeting regions with low coverage (intervention three) averts a slightly higher number of deaths and OOP expenditure. The reduced burden of rotavirus diarrhea is the primary driver of the estimated health and economic benefits in all intervention scenarios. All three interventions are cost saving. CONCLUSION Improving immunization coverage and the introduction of a rotavirus vaccine significantly alleviates disease and financial burden in Indian households. Population subgroups or regions with low existing immunization coverage benefit the most from the intervention. Increasing coverage by targeting those subgroups alleviates the burden more than simply increasing coverage in the population at large.
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Affiliation(s)
- Itamar Megiddo
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | - Abigail R Colson
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA; Princeton Environmental Institute, Princeton University, Princeton, NJ, USA
| | - Arindam Nandi
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | | | - Shankar Prinja
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA; Princeton Environmental Institute, Princeton University, Princeton, NJ, USA; Public Health Foundation of India, New Delhi, India.
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Verguet S, Gauvreau CL, Mishra S, MacLennan M, Murphy SM, Brouwer ED, Nugent RA, Zhao K, Jha P, Jamison DT. The consequences of tobacco tax on household health and finances in rich and poor smokers in China: an extended cost-effectiveness analysis. LANCET GLOBAL HEALTH 2015; 3:e206-16. [PMID: 25772692 DOI: 10.1016/s2214-109x(15)70095-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In China, there are more than 300 million male smokers. Tobacco taxation reduces smoking-related premature deaths and increases government revenues, but has been criticised for disproportionately affecting poorer people. We assess the distributional consequences (across different wealth quintiles) of a specific excise tax on cigarettes in China in terms of both financial and health outcomes. METHODS We use extended cost-effectiveness analysis methods to estimate, across income quintiles, the health benefits (years of life gained), the additional tax revenues raised, the net financial consequences for households, and the financial risk protection provided to households, that would be caused by a 50% increase in tobacco price through excise tax fully passed onto tobacco consumers. For our modelling analysis, we used plausible values for key parameters, including an average price elasticity of demand for tobacco of -0·38, which is assumed to vary from -0·64 in the poorest quintile to -0·12 in the richest, and we considered only the male population, which constitutes the overwhelming majority of smokers in China. FINDINGS Our modelling analysis showed that a 50% increase in tobacco price through excise tax would lead to 231 million years of life gained (95% uncertainty range 194-268 million) over 50 years (a third of which would be gained in the lowest income quintile), a gain of US$703 billion ($616-781 billion) of additional tax revenues from the excise tax (14% of which would come from the lowest income quintile, compared with 24% from the highest income quintile). The excise tax would increase overall household expenditures on tobacco by $376 billion ($232-505 billion), but decrease these expenditures by $21 billion (-$83 to $5 billion) in the lowest income quintile, and would reduce expenditures on tobacco-related disease by $24·0 billion ($17·3-26·3 billion, 28% of which would benefit the lowest income quintile). Finally, it would provide financial risk protection worth $1·8 billion ($1·2-2·3 billion), mainly concentrated (74%) in the lowest income quintile. INTERPRETATION Increased tobacco taxation can be a pro-poor policy instrument that brings substantial health and financial benefits to households in China. FUNDING Bill & Melinda Gates Foundation and Dalla Lana School of Public Health.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Cindy L Gauvreau
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Sujata Mishra
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mary MacLennan
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shane M Murphy
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Rachel A Nugent
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kun Zhao
- China National Health Development Research Center, Beijing, China
| | - Prabhat Jha
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Dean T Jamison
- Global Health Sciences, University of California, San Francisco, CA, USA
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Abstract
Vaccination has led to remarkable health gains over the last century. However, large coverage gaps remain, which will require significant financial resources and political will to address. In recent years, a compelling line of inquiry has established the economic benefits of health, at both the individual and aggregate levels. Most existing economic evaluations of particular health interventions fail to account for this new research, leading to potentially sizable undervaluation of those interventions. In line with this new research, we set forth a framework for conceptualizing the full benefits of vaccination, including avoided medical care costs, outcome-related productivity gains, behavior-related productivity gains, community health externalities, community economic externalities, and the value of risk reduction and pure health gains. We also review literature highlighting the magnitude of these sources of benefit for different vaccinations. Finally, we outline the steps that need to be taken to implement a broad-approach economic evaluation and discuss the implications of this work for research, policy, and resource allocation for vaccine development and delivery.
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Affiliation(s)
- Till Bärnighausen
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115; and Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba 3935, South Africa
| | - David E Bloom
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115; and
| | | | - Jennifer Carroll O'Brien
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115; and
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Rheingans R, Anderson JD, Anderson B, Chakraborty P, Atherly D, Pindolia D. Estimated impact and cost-effectiveness of rotavirus vaccination in India: Effects of geographic and economic disparities. Vaccine 2014; 32 Suppl 1:A140-50. [DOI: 10.1016/j.vaccine.2014.05.073] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rheingans R, Amaya M, Anderson JD, Chakraborty P, Atem J. Systematic review of the economic value of diarrheal vaccines. Hum Vaccin Immunother 2014; 10:1582-94. [PMID: 24861846 PMCID: PMC5396238 DOI: 10.4161/hv.29352] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/24/2014] [Indexed: 01/23/2023] Open
Abstract
Diarrheal disease is a leading cause of child mortality in low-income settings and morbidity across a range of settings. A growing number of studies have addressed the economic value of new and emerging vaccines to reduce this threat. We conducted a systematic review to assess the economic value of diarrheal vaccines targeting a range of pathogens in different settings. The majority of studies focused on the economic value of rotavirus vaccines in different settings, with most of these concluding that vaccination would provide significant economic benefits across a range of vaccine prices. There is also evidence of the economic benefits of cholera vaccines in specific contexts. For other potential diarrheal vaccines data are limited and often hypothetical. Across all target pathogens and contexts, the evidence of economic value focuses the short-term health and economic gains. Additional information is needed on the broader social and long-term economic value of diarrhea vaccines.
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Affiliation(s)
- Richard Rheingans
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
- Department of Health Services Research, Management & Policy; College of Public Health and Health Professions; University of Florida; Gainesville, FL USA
| | - Mirna Amaya
- Department of Health Services Research, Management & Policy; College of Public Health and Health Professions; University of Florida; Gainesville, FL USA
| | - John D Anderson
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
| | - Poulomy Chakraborty
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
| | - Jacob Atem
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
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Bartsch SM, Lee BY. Economics and financing of vaccines for diarrheal diseases. Hum Vaccin Immunother 2014; 10:1568-81. [PMID: 24755623 DOI: 10.4161/hv.28885] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The considerable burden of infectious disease-caused diarrhea around the world has motivated the continuing development of a number of vaccine candidates over the past several decades with some reaching the market. As with all major public health interventions, understanding the economics and financing of vaccines against diarrheal diseases is essential to their development and implementation. This review focuses on each of the major infectious pathogens that commonly cause diarrhea, the current understanding of their economic burden, the status of vaccine development, and existing economic evaluations of the vaccines. While the literature on the economics and financing of vaccines against diarrhea diseases is growing, there is considerable room for more inquiry. Substantial gaps exist for many pathogens, circumstances, and effects. Economics and financing studies are integral to vaccine development and implementation.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Computational and Operations Research (PHICOR); Johns Hopkins Bloomberg School of Public Health; Baltimore, MD USA; Department of Industrial Engineering; University of Pittsburgh; Pittsburgh, PA USA
| | - Bruce Y Lee
- Public Health Computational and Operations Research (PHICOR); Johns Hopkins Bloomberg School of Public Health; Baltimore, MD USA
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