1
|
Gurav YK, Bagepally BS, Chitpim N, Sobhonslidsuk A, Gupte MD, Chaikledkaew U, Thakkinstian A, Thavorncharoensap M. Cost-effective analysis of hepatitis A vaccination in Kerala state, India. PLoS One 2024; 19:e0306293. [PMID: 38935781 PMCID: PMC11210869 DOI: 10.1371/journal.pone.0306293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
Several hepatitis A outbreaks have recently been reported in Kerala state, India. To inform coverage decision of hepatitis A vaccine in Kerala, this study aimed to examine the cost-effectiveness of 1) hepatitis A vaccination among children aged 1 year and individuals aged 15 years, and 2) serological screening of individuals aged 15 years and vaccination of susceptible as compared to no vaccination or vaccination without serological screening. Both live attenuated hepatitis A vaccine and inactivated hepatitis A vaccine were considered in the analysis. A combination of decision tree and Markov models with a cycle length of one year was employed to estimate costs and benefits of different vaccination strategies. Analysis were based on both societal and payer perspectives. The lifetime costs and outcomes were discounted by 3%. Our findings indicated that all strategies were cost-saving for both societal and payer perspectives. Moreover, budget impact analysis revealed that vaccination without screening among individuals aged 15 years could save the government's budget by reducing treatment cost of hepatitis A. Our cost-effectiveness evidence supports the inclusion of hepatitis A vaccination into the vaccination program for children aged 1 year and individuals aged 15 years in Kerala state, India.
Collapse
Affiliation(s)
- Yogesh Krishnarao Gurav
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Health Technology Assessment Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Bhavani Shankara Bagepally
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Division of Non-Communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Natthakan Chitpim
- Social, Economic and Administrative Pharmacy Graduate Program, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Abhasnee Sobhonslidsuk
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| |
Collapse
|
2
|
Guimarães EL, Chissaque A, Pecenka C, Debellut F, Schuind A, Vaz B, Banze A, Rangeiro R, Mariano A, Lorenzoni C, Carrilho C, Martins MDRO, de Deus N, Clark A. Impact and Cost-Effectiveness of Alternative Human Papillomavirus Vaccines for Preadolescent Girls in Mozambique: A Modelling Study. Vaccines (Basel) 2023; 11:1058. [PMID: 37376447 DOI: 10.3390/vaccines11061058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 06/29/2023] Open
Abstract
Mozambique has one of the highest rates of cervical cancer in the world. Human papillomavirus (HPV) vaccination was introduced in 2021. This study evaluated the health and economic impact of the current HPV vaccine (GARDASIL® hereafter referred to as GARDASIL-4) and two other vaccines (CECOLIN® and CERVARIX®) that could be used in the future. A static cohort model was used to estimate the costs and benefits of vaccinating girls in Mozambique over the period 2022-2031. The primary outcome measure was the incremental cost per disability-adjusted life-year averted from a government perspective. We conducted deterministic and probabilistic sensitivity analyses. Without cross-protection, all three vaccines averted approximately 54% cervical cancer cases and deaths. With cross-protection, CERVARIX averted 70% of cases and deaths. Without Gavi support, the discounted vaccine program costs ranged from 60 million to 81 million USD. Vaccine program costs were approximately 37 million USD for all vaccines with Gavi support. Without cross-protection, CECOLIN was dominant, being cost-effective with or without Gavi support. With cross-protection and Gavi support, CERVARIX was dominant and cost-saving. With cross-protection and no Gavi support, CECOLIN had the most favorable cost-effectiveness ratio. Conclusions: At a willingness-to-pay (WTP) threshold set at 35% of Gross Domestic Product (GDP) per capita, HPV vaccination is cost-effective in Mozambique. The optimal vaccine choice depends on cross-protection assumptions.
Collapse
Affiliation(s)
- Esperança Lourenço Guimarães
- Instituto Nacional de Saúde, Marracuene District, EN1, Bairro da Vila-Parcela N° 3943, Maputo 1120, Mozambique
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Junqueira Street 100, 1349-008 Lisbon, Portugal
| | - Assucênio Chissaque
- Instituto Nacional de Saúde, Marracuene District, EN1, Bairro da Vila-Parcela N° 3943, Maputo 1120, Mozambique
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Junqueira Street 100, 1349-008 Lisbon, Portugal
| | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
| | - Frédéric Debellut
- Center for Vaccine Innovation and Access, PATH, 1202 Geneva, Switzerland
| | - Anne Schuind
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
| | | | | | - Ricardina Rangeiro
- National Cancer Control Program, Hospital Central de Maputo, Maputo 1101, Mozambique
| | - Arlete Mariano
- National Cancer Control Program, Hospital Central de Maputo, Maputo 1101, Mozambique
| | - Cesaltina Lorenzoni
- National Cancer Control Program, Hospital Central de Maputo, Maputo 1101, Mozambique
| | - Carla Carrilho
- Department of Pathology, Universidade Eduardo Mondlane, Maputo 3453, Mozambique
| | - Maria do Rosário Oliveira Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Junqueira Street 100, 1349-008 Lisbon, Portugal
| | - Nilsa de Deus
- Instituto Nacional de Saúde, Marracuene District, EN1, Bairro da Vila-Parcela N° 3943, Maputo 1120, Mozambique
| | - Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| |
Collapse
|
3
|
Prinja S, Sharma A, Nadipally S, Rana SK, Bahuguna P, Rao N, Chakraborty G, Shankar M, Rai V. Impact and cost-effectiveness evaluation of nutritional supplementation and complementary interventions for tuberculosis treatment outcomes under mukti pay-for-performance model in Madhya Pradesh, India: A study protocol. Int J Mycobacteriol 2023; 12:82-91. [PMID: 36926768 DOI: 10.4103/2212-5531.307071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background A. "pay-for-performance" (P4P) intervention model for improved tuberculosis (TB) outcomes, called "Mukti," has been implemented in an underdeveloped tribal area of central India. The target of this project is to improve nutritional status, quality of life (QoL), and treatment outcomes of 1000 TB patients through four interventions: food baskets, personal counseling, peer-to-peer learning and facilitation for linkage to government schemes. The current study aims to assess the success of this model by evaluating its impact and cost-effectiveness using a quasi-experimental approach. Methods Data for impact assessment have been collected from 1000 intervention and control patients. Study outcomes such as treatment completion, sputum negativity, weight gain, and health-related QoL will be compared between matched samples. Micro costing approach will be used for assessing the cost of routine TB services provision under the national program and the incremental cost of implementing our interventions. A decision and Markov hybrid model will estimate long-term costs and health outcomes associated with the use of study interventions. Measures of health outcomes will be mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per quality-adjusted life-years gained and cost per unit increase in patient weight in intervention versus control groups. Results The evidence generated from the present study in terms of impact and cost-effectiveness estimates will thus help to identify not only the effectiveness of these interventions but also the optimal mode of financing such measures. Our estimates on scale-up costs for these interventions will also help the state and the national government to consider scale-up of such interventions in the entire state or country. Discussion The study will generate important evidence on the impact of nutritional supplementation and other complementary interventions for TB treatment outcomes delivered through P4P financing models and on the cost of scaling up these to the state and national level in India.
Collapse
Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer Nadipally
- Partnership for Affordable Healthcare, Access and Longevity, IPE Global Pvt. Ltd, New Delhi, India
| | - Saroj Kumar Rana
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India; School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Neeta Rao
- US Agency for International Development, New Delhi, India
| | | | - Manjunath Shankar
- Partnership for Affordable Healthcare, Access and Longevity, IPE Global Pvt. Ltd, New Delhi, India
| | - Varsha Rai
- State TB Office, National Tuberculosis Elimination Program, Government of Madhya Pradesh, India
| |
Collapse
|
4
|
Rajkhowa P, Patil DS, Dsouza SM, Narayanan P, Brand H. Evidence on factors influencing HPV vaccine implementation in South Asia: A scoping review. Glob Public Health 2023; 18:2288269. [PMID: 38063361 DOI: 10.1080/17441692.2023.2288269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
Cervical cancer is a significant public health concern globally, with low and middle-income countries bearing the highest burden, specifically the South Asian region. Therefore, the current scoping review aimed to highlight the factors influencing the implementation of human papillomavirus (HPV) vaccination in South Asia. Adopting the 'Arksey and O'Malley and Levac et al.' methodology, multiple electronic databases were searched to identify relevant records. The results were narratively synthesised and discussed, adopting the Consolidated Framework for Implementation Research (CFIR) model. We identified 527 records, which were assessed for eligibility based on title, abstract, and full text by three reviewers, followed by data extraction of 29 studies included for analysis in the review. Implementing HPV vaccination programs in South Asia faces various challenges, such as economic, health system, financial, health literacy, and sociocultural factors that hinder their successful implementation. To successfully implement the vaccine, a tailored risk communication strategy is necessary for these countries. Knowledge gained from the experience of South Asian nations in implementing the HPV vaccine can assist in policymaking in similar healthcare for advancing the implementation of HPV vaccination.
Collapse
Affiliation(s)
- Priyobrat Rajkhowa
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Divya Sussana Patil
- Public Health Evidence South Asia, Department of Health Information, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sherize Merlin Dsouza
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Prakash Narayanan
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Helmut Brand
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
5
|
Shah K, Singh M, Kotwani P, Tyagi K, Pandya A, Saha S, Saxena D, Rajshekar K. Comprehensive league table of cost-utility ratios: A systematic review of cost-effectiveness evidence for health policy decisions in India. Front Public Health 2022; 10:831254. [PMID: 36311623 PMCID: PMC9606776 DOI: 10.3389/fpubh.2022.831254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/22/2022] [Indexed: 01/21/2023] Open
Abstract
Background and objectives Although a relatively recent concept for developing countries, the developed world has been using League Tables as a policy guiding tool for a comprehensive assessment of health expenditures; country-specific "League tables" can be a very useful tool for national healthcare planning and budgeting. Presented herewith is a comprehensive league table of cost per Quality Adjusted Life Years (QALY) or Disability Adjusted Life Years (DALY) ratios derived from Health Technology Assessment (HTA) or economic evaluation studies reported from India through a systematic review. Methods Economic evaluations and HTAs published from January 2003 to October 2019 were searched from various databases. We only included the studies reporting common outcomes (QALY/DALY) and methodology to increase the generalizability of league table findings. To opt for a uniform criterion, a reference case approach developed by Health Technology Assessment in India (HTAIn) was used for the reporting of the incremental cost-effectiveness ratio. However, as, most of the articles expressed the outcome as DALY, both (QALY and DALY) were used as outcome indicators for this review. Results After the initial screening of 9,823 articles, 79 articles meeting the inclusion criteria were selected for the League table preparation. The spectrum of intervention was dominated by innovations for infectious diseases (33%), closely followed by maternal and child health (29%), and non-communicable diseases (20%). The remaining 18% of the interventions were on other groups of health issues, such as injuries, snake bites, and epilepsy. Most of the interventions (70%) reported DALY as an outcome indicator, and the rest (30%) reported QALY. Outcome and cost were discounted at the rate of 3 by 73% of the studies, at 5 by 4% of the studies, whereas 23% of the studies did not discount it. Budget impact and sensitivity analysis were reported by 18 and 73% of the studies, respectively. Interpretation and conclusions The present review offers a reasonably coherent league table that reflects ICER values of a range of health conditions in India. It presents an update for decision-makers for making decisions about resource allocation.
Collapse
Affiliation(s)
- Komal Shah
- Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India,*Correspondence: Komal Shah
| | - Malkeet Singh
- HTAIn Secretariat-Department of Health Research, New Delhi, India
| | | | - Kirti Tyagi
- HTAIn Secretariat-Department of Health Research, New Delhi, India
| | - Apurvakumar Pandya
- Faculty of Medicine, Parul Institute of Public Health, Parul University, Vadodara, India
| | - Somen Saha
- Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India
| | - Deepak Saxena
- Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India
| | | |
Collapse
|
6
|
Frianto D, Setiawan D, Diantini A, Suwantika AA. Economic Evaluations of HPV Vaccination in Targeted Regions of Low- and Middle-Income Countries: A Systematic Review of Modelling Studies. Int J Womens Health 2022; 14:1315-1322. [PMID: 36119804 PMCID: PMC9480583 DOI: 10.2147/ijwh.s367953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background In countries with limited resources, a targeted HPV vaccination strategy by focusing in selected regions is preferable to be implemented than a nationwide vaccination strategy. Objective This study aimed to review articles on economic evaluations of HPV vaccination in countries over the world that applied targeted vaccination strategies. Methods Approximately 1769 articles were obtained from two databases (1242 and 527 articles from PubMed and ProQuest, respectively). The inclusion criteria in this systematic review were studies about full economic evaluations of HPV vaccination in targeted area or sub-national level and written in English. Full-text screening was applied to evaluate the eligibility. Final articles obtained were referred to the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist. Finally, we included only 4 articles that met all inclusion and exclusion criteria. Results Included studies in this review focused in different targeted regions, such as Punjab State in India, Vientiane in Lao PDR, Southern Vietnam in Vietnam, and Brazilian Amazon in Brazil. From 24 criteria in the CHEERS checklist, all included studies could meet 21 criteria (87.5%). All included studies in this review applied modeling approaches, which can estimate the number of cases and treatment costs averted. Applying various settings, the results of this study showed that HPV vaccination could potentially reduce the number of cervical cancer cases by 20–72%. Taking cervical cancer screening into account, this study showed that targeted HPV vaccination was cost-effective or even cost-saving. Conclusion Implementation of HPV vaccination in sub-national level as the initial step before nationwide vaccination is more favorable to be implemented in countries with limited budget.
Collapse
Affiliation(s)
- Dedy Frianto
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Faculty of Pharmacy, Universitas Buana Perjuangan, Karawang, Indonesia
| | - Didik Setiawan
- Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| |
Collapse
|
7
|
Ahuja M, Sharma P, Sarkar A. Universal Cervical Cancer Immunization: India Ready for a Quantum Leap. J Midlife Health 2022; 13:260-262. [PMID: 36950205 PMCID: PMC10025827 DOI: 10.4103/jmh.jmh_224_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Maninder Ahuja
- Director, Ahuja Health Care Services, ESIC Medical College, Faridabad, Haryana, India
| | - Priyanka Sharma
- Department of Obstetrics and Gynaecology, ESIC Medical College, Faridabad, Haryana, India
| | - Avir Sarkar
- Department of Obstetrics and Gynaecology, ESIC Medical College, Faridabad, Haryana, India
| |
Collapse
|
8
|
Gupta N, Nehra P, Chauhan AS, Mehra N, Singh A, Krishnamurthy MN, Rajsekhar K, Kalaiyarasi JP, Roy PS, Malik PS, Mathew A, Malhotra P, Kataki AC, Dixit J, Gupta S, Kumar L, Prinja S. Cost Effectiveness of Bevacizumab Plus Chemotherapy for the Treatment of Advanced and Metastatic Cervical Cancer in India-A Model-Based Economic Analysis. JCO Glob Oncol 2022; 8:e2100355. [PMID: 35286136 PMCID: PMC8932481 DOI: 10.1200/go.21.00355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Patients with advanced and metastatic cervical cancer have a poor prognosis with a 1-year survival rate of 10%-15%. Recently, an antiangiogenic humanized monoclonal antibody bevacizumab has shown to improve the survival of these patients. This study was designed to assess the cost effectiveness of incorporating bevacizumab with standard chemotherapy for the treatment of patients with advanced and metastatic cervical cancer in India.
Collapse
Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Prerika Nehra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | | | - Kavitha Rajsekhar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Partha Sarathi Roy
- Department of Medical Oncology, Dr B. Booroah Cancer Institute, Guwahati, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anisha Mathew
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amal Chandra Kataki
- Department of Gynaecologic Oncology, Dr B. Booroah Cancer Institute, Guwahati, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
9
|
Iyengar S, Kantor K, Cyriac S, Remadevi K, Usha V, Robinson S, Rani A, Rajagopal MR, Broderick A. No Family Should Suffer From Cervical Cancer Twice-The Palliative Care Role in HPV Prevention. J Pain Symptom Manage 2022; 63:e17-e20. [PMID: 34256090 DOI: 10.1016/j.jpainsymman.2021.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/05/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cervical cancer, caused by human papillomavirus infection, is the source of significant personal and societal burden, and robs more than one hundred thousand Indian women and their families of the chances of a healthy and productive life each year. As outlined by the World Health Organization, the three-pronged approach of screening, vaccination, and reduction in mortality by early treatment presents the possibility of the elimination of cervical cancer as a public health problem in the next decade.1 Unfortunately, these approaches are all associated with significant barriers in India. OBJECTIVES Given that the main mandate of palliative care practitioners to prevent and relieve suffering, here we make the case for these practitioners to offer education around vaccination and screening to female relatives of women encountered with cervical cancer. CONCLUSION Offering prevention strategies for human papillomavirus aligns with the idea of preventing suffering and is within the scope of palliative care clinicians.
Collapse
Affiliation(s)
- Sloka Iyengar
- Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Pallium India, Kerala, India.
| | - Kaley Kantor
- Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Pallium India, Kerala, India
| | - Sunu Cyriac
- Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Keerthi Remadevi
- Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Pallium India, Kerala, India
| | - Vidhya Usha
- Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Pallium India, Kerala, India
| | - Sherin Robinson
- Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Pallium India, Kerala, India
| | - Ashla Rani
- Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Pallium India, Kerala, India
| | - M R Rajagopal
- Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Pallium India, Kerala, India
| | - Ann Broderick
- Hospice and Palliative Care, Veterans Administration Medical Center, Iowa City, IA, USA
| |
Collapse
|
10
|
Khurana T, Gupta A, Rathi H. The state of cost-utility analysis in India: A systematic review. Perspect Clin Res 2021; 12:179-183. [PMID: 34760643 PMCID: PMC8525785 DOI: 10.4103/picr.picr_256_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022] Open
Abstract
Aims: Cost-utility studies are crucial tools that help policy-makers promote appropriate resource allocation. The objective of this study was to evaluate the extent and quality of cost-utility analysis (CUA) in India through a systematic literature review. Methods: Comprehensive database search was conducted to identify the relevant literature published from November 2009 to November 2019. Gray literature and hand searches were also performed. Two researchers independently reviewed and assessed study quality using Consolidated Health Economic Evaluation Reporting Standards checklist. Results: Thirty-five studies were included in the final review. Thirteen studies used Markov model, five used decision tree model, four used a combination of decision tree and Markov model and one each used microsimulation and dynamic compartmental model. The primary therapeutic areas targeted in CUA were infectious diseases (n = 12), ophthalmology (n = 5), and endocrine disorders (n = 4). Five studies were carried out in Tamil Nadu, four in Goa, three in Punjab, two each in Delhi, Maharashtra, and Uttar Pradesh, and one each in West Bengal and Karnataka. Twenty-three, eight, and four studies were found to be of excellent, very good, and good quality, respectively. The average quality score of the studies was 19.21 out of 24. Conclusions: This systematic literature review identified the published CUA studies in India. The overall quality of the included studies was good; however, features such as subgroup analyses and explicit study perspective were missing in several evaluations.
Collapse
Affiliation(s)
- Tanu Khurana
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India
| | - Amit Gupta
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India
| | - Hemant Rathi
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India.,Health Economics and Outcomes Research, Skyward Analytics Pte. Limited Singapore, Singapore
| |
Collapse
|
11
|
Schueller E, Nandi A, Summan A, Chatterjee S, Ray A, Haldar P, Laxminarayan R. Public Finance of Universal Routine Childhood Immunization in India: District Level Cost Estimates. Health Policy Plan 2021; 37:200-208. [PMID: 34522955 PMCID: PMC8826633 DOI: 10.1093/heapol/czab114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/06/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022] Open
Abstract
India’s Universal Immunization Programme (UIP) is among the largest routine childhood vaccination programmes in the world. However, only an estimated 65% of Indian children under the age 2 years were fully vaccinated in 2019. We estimated the cost of raising childhood vaccination coverage to a minimum of 90% in each district in India. We obtained vaccine price data from India’s comprehensive multi-year strategic plan for immunization. Cost of vaccine delivery by district was derived from a 2018 field study in 24 districts. We used propensity score matching methods to match the remaining Indian districts with these 24, based on indicators from the National Family Health Survey (2015–16). We assumed the same unit cost of vaccine delivery in matched pair districts and estimated the total and incremental cost of providing routine vaccines to 90% of the current cohort of children in each district. The estimated national cost of providing basic vaccinations—one dose each of Bacillus Calmette–Guerin (BCG) and measles vaccines, and three doses each of oral polio (OPV) and diphtheria, pertussis and tetanus vaccines—was $784.91 million (2020 US$). Considering all childhood vaccines included in UIP during 2018–22 (one dose each of BCG, hepatitis B and measles–rubella; four doses of OPV; two doses of inactivated polio; and three doses each of rotavirus, pneumococcal and pentavalent vaccines), the estimated national cost of vaccines and delivery to 90% of target children in each district was $1.73 billion. The 2018 UIP budget for vaccinating children, pregnant women and adults was $1.17 billion (2020 US$). In comparison, $1.73 billion would be needed to vaccinate 90% of children in all Indian districts with the recommended schedule of routine childhood vaccines. Additional costs for infrastructural investments and communication activities, not incorporated in this study, may also be necessary.
Collapse
Affiliation(s)
- Emily Schueller
- Center for Disease Dynamics, Economics & Policy, Washington DC, USA
| | - Arindam Nandi
- The Population Council, New York, NY.,Center for Disease Dynamics, Economics & Policy, Washington DC, USA
| | - Amit Summan
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | - Susmita Chatterjee
- George Institute for Global Health, New Delhi, India.,University of New South Wales, Sydney, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, India
| | - Arindam Ray
- Bill & Melinda Gates Foundation, India Country Office, New Delhi, India
| | - Pradeep Haldar
- Ministry of Health and Family Welfare, Government of India
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi, India.,High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
| |
Collapse
|
12
|
Gupta N, Prinja S, Patil V, Bahuguna P. Cost-Effectiveness of Temozolamide for Treatment of Glioblastoma Multiforme in India. JCO Glob Oncol 2021; 7:108-117. [PMID: 33449801 PMCID: PMC8081547 DOI: 10.1200/go.20.00288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Glioblastoma multiforme (GBM) has poor outcomes following surgery and radiation. Adjuvant temozolamide along with radiation therapy has been shown to improve survival. In this paper, we evaluate the cost-effectiveness of concomitant temozolamide with radiation and maintenance temozolamide for 6 months of treatment for GBM in India. MATERIALS AND METHODS We used a Markov model to evaluate the lifetime costs and consequences of treating GBM with radiation alone versus radiation with adjuvant temozolamide. The model was calibrated using the published evidence from European Organisation for Research and Treatment of Cancer-NCIC trial on progression-free survival and overall survival to estimate the life years (LYs) and quality-adjusted LYs (QALYs). Cost of treatment and management of complications were estimated using the data from the National Health System Cost Database and Indian studies. Future cost and consequences were discounted at 3%. Incremental cost per QALY gained with temozolamide was estimated to assess cost effectiveness. RESULTS Temozolamide resulted in an increase of 0.59 (0.53-0.66) LY and 0.33 (0.29-0.40) QALY per person at an incremental cost of ₹75,120 in Indian national rupee (INR) (59,337-93,960). Overall, the use of temozolamide incurs an incremental cost of ₹212,020 INR (138,127-401,466) per QALY gained, which has a 4.7% probability to be cost-effective at 1-time per capita Gross Domestic Product (GDP) threshold. In case the current price of temozolamide could be decreased by 90%, the probability of its use for GBM being cost-effective increases to 80%. CONCLUSION Temozolamide is not cost-effective for treatment of patients with GBM in India. This evidence should be used while framing guidelines for treatment and price regulation.
Collapse
Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
13
|
Gupta N, Verma RK, Gupta S, Prinja S. Cost Effectiveness of Trastuzumab for Management of Breast Cancer in India. JCO Glob Oncol 2021; 6:205-216. [PMID: 32045547 PMCID: PMC7051799 DOI: 10.1200/jgo.19.00293] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE We undertook this study to evaluate the incremental cost per quality-adjusted life-year (QALY) gained with use of adjuvant trastuzumab as compared with chemotherapy alone among patients with nonmetastatic breast cancer in India. METHODS We used a Markov model to estimate the incremental cost of using trastuzumab (for 1 year, 6 months, or 9 weeks) as compared with chemotherapy alone using a societal perspective, excluding indirect productivity losses. Although the outcomes (QALYs) in the standard chemotherapy arm were estimated after calibrating the model as per survival data from 2 Indian cancer registries, effectiveness estimates from the HERA trial and a joint analysis of the NSABP B-31 and NCCTG N9831 trials were used to estimate the consequences of 1-year trastuzumab use. The cost of treatment was estimated using national standard treatment guidelines and real-world use estimates for different treatment modalities as per data from Indian cancer registries. Probabilistic sensitivity analysis was undertaken to evaluate parameter uncertainty. RESULTS For 1 year of trastuzumab use, the incremental benefit per patient, incremental cost per QALY gained, and probability of being cost effective using HERA trial estimates were 1.29 QALYs, 178,877 Indian national rupees (INRs; US$2,558), and 4%, respectively, whereas the corresponding figures using joint analysis estimates were 1.69 QALYs, INR 134,413 (US$1,922), and 57.3%, respectively. CONCLUSION Use of trastuzumab for 1 year is not cost effective in India at the current price. However, trastuzumab use for 9 weeks is cost effective and should be included in clinical guidelines and reimbursement policies. A price reduction of 15% to 35% increases the probability of 1-year trastuzumab use being cost effective, to 90%.
Collapse
Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Rohan Kumar Verma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudeep Gupta
- Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
14
|
Singh D, Prinja S, Bahuguna P, Chauhan AS, Guinness L, Sharma S, Lakshmi PVM. Cost of scaling-up comprehensive primary health care in India: Implications for universal health coverage. Health Policy Plan 2021; 36:407-417. [PMID: 33693828 DOI: 10.1093/heapol/czaa157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 11/14/2022] Open
Abstract
India has announced the ambitious program to transform the current primary healthcare facilities to health and wellness centres (HWCs) for provision of comprehensive primary health care (CPHC). We undertook this study to assess the cost of this scale-up to inform decisions on budgetary allocation, as well as to set the norms for capitation-based payments. The scale-up cost was assessed from both a financial and an economic perspective. Primary data on resources used to provide services in 93 sub-health centres (SHCs) and 38 primary health care centres (PHCs) were obtained from the National Health System Cost Database. The cost of additional infrastructure and human resources was assessed against the normative guidelines of Indian Public Health Standards and the HWC. The cost of other inputs (drugs, consumables, etc.) was determined by undertaking the need estimation based on disease burden or programme guidelines, standard treatment guidelines and extent and pattern of care utilization from nationally representative sample surveys. The financial cost is reported in terms of the annual incremental cost at health facility level, as well as its implications at national level, given the planned scale-up path. Secondly, economic cost is assessed as the total annual as well as annual per capita cost of services at HWC level. Bootstrapping technique was undertaken to estimate 95% confidence intervals for cost estimations. Scaling to CPHC through HWC would require an additional ₹ 721 509 (US$10 178) million allocation of funds for primary healthcare >5 years from 2019 to 2023. The scale-up would imply an addition to Government of India's health budget of 2.5% in 2019 to 12.1% in 2023. Our findings suggest a scale-up cost of 0.15% of gross domestic product (GDP) for full provision of CPHC which compares with current public health spending of 1.28% of GDP and a commitment of 2.5% of GDP by 2025 in the National Health Policy. If a capitation-based payment system was used to pay providers, provision of CPHC would need to be paid at between ₹ 333 (US$4.70) and ₹ 253 (US$3.57) per person covered for SHC and PHC, respectively.
Collapse
Affiliation(s)
- Diksha Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lorna Guinness
- Centre for Global Development (Europe), Great College St, Westminster, London SW1P 3SE, UK
| | - Sameer Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
15
|
Radhakrishnan V, Lam CG, Howard SC. Vaccination Against Cervical Cancer in India: Our Children Deserve a Healthier Future. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1731843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Venkatraman Radhakrishnan
- Department of Medical and Pediatric Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Catherine G Lam
- Director of Health Systems and Asia Pacific Regional Programs, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Scott C Howard
- Professor and Associate Dean for Research in the College of Nursing University of Tennessee College of Health Sciences, Memphis, TN, USA
| |
Collapse
|
16
|
Mandal R, Banerjee D, Gupta K, Chatterjee P, Vernekar M, Ray C. Experience of Human Papillomavirus Vaccination Project in a Community Set Up-An Indian Study. Asian Pac J Cancer Prev 2021; 22:699-704. [PMID: 33773531 PMCID: PMC8286678 DOI: 10.31557/apjcp.2021.22.3.699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Initial introduction of HPV vaccination from 2006 to 2008 was largely confined to high-income countries (HIC), such as Australia, the United States, and Europe, where cervical cancer incidence is lowest. Much of the post-introduction literature has come from HICs, with a focus on coverage levels achieved, provider acceptability and early impact of vaccination on disease endpoints. However, there are a few literature evaluating the mechanics of delivery, feasibility of the health system and acceptability from low and middle income countries (LMICs). The primary objective was to evaluate the feasibility, acceptability and safety of two dose HPV vaccination in adolescent girls between 9-14 years. Methods: After an orientation camp followed by filling up of prevaccine questionnaires by parents on HPV related diseases and its vaccines and informed consent, girls between9-14years were vaccinated. They were asked to report any side effects in the next 24 hours after each dose. Parents were contacted on Day 7 and Day 30 to enquire about any side effects . Total 3 visits were required i.e two for the vaccination and one visit at 7th month post completion of second dose. To estimate the acceptability, successful completion of two doses by at least 80% of the girls were measured. For measurement of acceptability, either of the parents were recalled along with their daughter at 7th month and were asked to fill up a pre-set questionnaire. Results: After institutional ethical clearance, 555 girls were recruited in the study from rural parts of West Bengal, India between July, 2017 to November, 2017. Out of which, 544 girls (98%) received their 2nd dose between January, 2018 and May, 2018 without any serious adverse effects. No serious adverse effect was reported on follow up till December, 2019. Conclusion: The introduction of HPV vaccination is feasible in large scale and the vaccine is well accepted and safe.
Collapse
Affiliation(s)
- Ranajit Mandal
- Department of Gynaecological Oncology, Chittaranjan National Cancer Institute, 37 S P Mukherjee Road, Kolkata-700026, West Bengal, India
| | - Dipanwita Banerjee
- Department of Gynaecological Oncology, Chittaranjan National Cancer Institute, 37 S P Mukherjee Road, Kolkata-700026, West Bengal, India
| | - Krishnendu Gupta
- Department of Gynaecology and Obstetrics, Vivekananda Institution of Medical Sciences, 99 Sarat Bose Road, Kolkata-26, India
| | - Puja Chatterjee
- Department of Gynaecological Oncology, Chittaranjan National Cancer Institute, 37 S P Mukherjee Road, Kolkata-700026, West Bengal, India
| | - Manisha Vernekar
- Department of Gynaecological Oncology, Chittaranjan National Cancer Institute, 37 S P Mukherjee Road, Kolkata-700026, West Bengal, India
| | - Chandrima Ray
- Department of Surgical Oncology, Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, Uttar Pradesh, India
| |
Collapse
|
17
|
Chugh Y, Premkumar M, Grover GS, Dhiman RK, Teerawattananon Y, Prinja S. Cost-effectiveness and budget impact analysis of facility-based screening and treatment of hepatitis C in Punjab state of India. BMJ Open 2021; 11:e042280. [PMID: 33589457 PMCID: PMC7887370 DOI: 10.1136/bmjopen-2020-042280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Despite treatment availability, chronic hepatitis C virus (HCV) public health burden is rising in India due to lack of timely diagnosis. Therefore, we aim to assess incremental cost per quality-adjusted life year (QALY) for one-time universal screening followed by treatment of people infected with HCV as compared with a no screening policy in Punjab, India. STUDY DESIGN Decision tree integrated with Markov model was developed to simulate disease progression. A societal perspective and a 3% annual discount rate were considered to assess incremental cost per QALY gained. In addition, budgetary impact was also assessed with a payer's perspective and time horizon of 5 years. STUDY SETTING Screening services were assumed to be delivered as a facility-based intervention where active screening for HCV cases would be performed at 22 district hospitals in the state of Punjab, which will act as integrated testing as well as treatment sites for HCV. INTERVENTION Two intervention scenarios were compared with no universal screening and treatment (routine care). Scenario I-screening with ELISA followed by confirmatory HCV-RNA quantification and treatment. Scenario II-screening with rapid diagnostic test (RDT) kit followed by confirmatory HCV-RNA quantification and treatment. PRIMARY AND SECONDARY OUTCOME MEASURES Lifetime costs; life years and QALY gained; and incremental cost-effectiveness ratio for each of the above-mentioned intervention scenario as compared with the routine care. RESULTS Screening with ELISA and RDT, respectively, results in a gain of 0.028 (0.008 to 0.06) and 0.027 (0.008 to 0.061) QALY per person with costs decreased by -1810 Indian rupees (-3376 to -867) and -1812 Indian rupees (-3468 to -850) when compared with no screening. One-time universal screening of all those ≥18 years at a base coverage of 30%, with ELISA and RDT, would cost 8.5 and 8.3 times more, respectively, when compared with screening the age group of the cohort 40-45 years old. CONCLUSION One-time universal screening followed by HCV treatment is a dominant strategy as compared with no screening. However, budget impact of screening of all ≥18-year-old people seems unsustainable. Thus, in view of findings from both cost-effectiveness and budget impact, we recommend beginning with screening the age cohort with RDT around mean age of disease presentation, that is, 40-45 years, instead of all ≥18-year-old people.
Collapse
Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, Punjab, India
| | - Madhumita Premkumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gagandeep Singh Grover
- Department of Health and Family Welfare, National Viral Hepatitis Control Program, Government of Punjab, Chandigarh, India
| | - Radha K Dhiman
- Director, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Mueang Nonthaburi, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore, Singapore
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
18
|
Shetty S, Shetty V, Badiger S, Shetty AK. An exploratory study of undergraduate healthcare student perspectives regarding human papillomavirus and vaccine intent in India. WOMEN'S HEALTH 2021; 17:17455065211055304. [PMID: 34713762 PMCID: PMC8558803 DOI: 10.1177/17455065211055304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Safe and effective human papillomavirus vaccines are available against cervical cancer and other human papillomavirus–associated diseases. Vaccine uptake is low in India given lack of universal vaccination programme. This exploratory study describes the medical, dental and nursing undergraduate student perspectives about human papillomavirus and intentions to receive the vaccine. Methods: Using a cross-sectional, explorative study design, we conducted two focus group discussions among a convenience sample of male (n = 11) and female (n = 9) student group aged ⩾18 years, respectively, at a medical college in South India. The focus group discussion sessions were recorded, transcribed and analysed using thematic content analysis. Results: Over half of the students showed adequate knowledge of cervical cancer and human papillomavirus. Medical students had much in-depth knowledge of cervical cancer, vaccine cost and its side effects compared to dental and nursing students. Human papillomavirus vaccine knowledge was relatively less among males compared to females; most male participants were unaware of the availability of the human papillomavirus vaccine. Intention to receive the vaccine was higher among females than males. All the participants had positive attitude in creating awareness in the community and making the vaccine cost-effective. Cultural concerns and high vaccine cost were cited major barriers for vaccine uptake. Suggestion of physician recommendation in promotion of human papillomavirus vaccine uptake was an emerging theme. Conclusion: Educating male students and those enrolled in dental and nursing courses about human papillomavirus vaccine, addressing cultural concerns and advocating provider recommendation for promoting vaccine uptake are potential strategies to improve future human papillomavirus vaccine intent among students and recommendations to patients in their role as future healthcare provider.
Collapse
Affiliation(s)
- Seemitha Shetty
- K S Hegde Medical Academy (KSHEMA) and NITTE (Deemed to be University), Mangaluru, India
| | - Veena Shetty
- K S Hegde Medical Academy (KSHEMA) and NITTE (Deemed to be University), Mangaluru, India
- Department of Microbiology, K S Hegde Medical Academy (KSHEMA) and NITTE (Deemed to be University), Mangaluru, India
| | - Sanjeev Badiger
- K S Hegde Medical Academy (KSHEMA) and NITTE (Deemed to be University), Mangaluru, India
- Department of Community Medicine, K S Hegde Medical Academy (KSHEMA) and NITTE (Deemed to be University), Mangaluru, India
| | - Avinash K Shetty
- Department of Pediatrics, Wake Forest School of Medicine and Brenner Children’s Hospital, Winston-Salem, NC, USA
- Office of Global Health and Department of Pediatrics, Wake Forest School of Medicine and Brenner Children’s Hospital, Winston-Salem, NC, USA
| |
Collapse
|
19
|
Min KJ, Suh DH, Baba T, Chen X, Kim JW, Kobayashi Y, Kwon J, Lim MC, Lee JY, Nagase S, Park JY, Tangjitgamol S, Watari H. Time for enhancing government-led primary prevention of cervical cancer. J Gynecol Oncol 2020; 32:e12. [PMID: 33327045 PMCID: PMC7767652 DOI: 10.3802/jgo.2021.32.e12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Kyung Jin Min
- Department of Obstetrics and Gynecology, Korea University Medicine, Korea University, Seoul, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Janice Kwon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Myong Cheol Lim
- Cancer Healthcare Research Branch, Center for Uterine Cancer, and Center for Clinical Trials, National Cancer Center, Goyang, Korea
| | - Jung Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Jeong Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Siriwan Tangjitgamol
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.,Obstetrics and Gynecology Section, MedPark Hospital, Bangkok, Thailand
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
20
|
Okeah BO, Ridyard CH. Factors Influencing the Cost-Effectiveness Outcomes of HPV Vaccination and Screening Interventions in Low-to-Middle-Income Countries (LMICs): A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:641-654. [PMID: 32468410 DOI: 10.1007/s40258-020-00576-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cervical cancer ranks fourth amongst the commonest malignancies worldwide and the second most prevalent cancer afflicting women in low-to-middle income countries (LMICs), hence, of great public health importance. LMICs are the most affected regions as evidenced by their high prevalence of the disease. Mortality associated with cervical neoplasms is preventable through the implementation of recommended preventive approaches. AIMS This review aimed to appraise evidence on the cost effectiveness of cervical cancer prevention interventions in LMICs involving cervical screening and human papilloma virus (HPV) vaccination programmes. METHODS A search of CINAHL, MEDLINE, PubMed, and Web of Science was elicited and studies published between 1st January 2008 and 31st December 2018 were retrieved. Two authors independently undertook the screening, review, selection of studies, and data extraction with disagreements being resolved through discussion and consensus. RESULTS Twelve studies were selected. The cost-effectiveness outcomes of HPV vaccination and screening interventions are dependent on age, screening method used, intervention coverage, and the number of doses or visits required for vaccination and screening, respectively. A combination of visual inspection with acetic acid (VIA) screening and HPV vaccination appears to be the most cost-effective approach in reducing the lifetime risk for HPV-linked cervical neoplasms. Similarly, vaccination as a stand-alone intervention is potentially cost effective provided the coverage is maintained between 70 and 100%. CONCLUSIONS HPV vaccination and screening interventions may be cost effective in LMICs and potentially reduce the lifetime risk, economic burden, and associated mortality. However, it is important to consider the factors that influence the cost effectiveness of cervical cancer prevention interventions for better outcomes to be realised.
Collapse
Affiliation(s)
- Bernard O Okeah
- School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, LL57 2EF, UK
| | - Colin H Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Normal Site, Bangor, Gwynedd, LL57 2PZ, UK.
| |
Collapse
|
21
|
Chauhan AS, Prinja S, Srinivasan R, Rai B, Malliga JS, Jyani G, Gupta N, Ghoshal S. Cost effectiveness of strategies for cervical cancer prevention in India. PLoS One 2020; 15:e0238291. [PMID: 32870941 PMCID: PMC7462298 DOI: 10.1371/journal.pone.0238291] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/13/2020] [Indexed: 01/20/2023] Open
Abstract
The establishment of link between high-risk human papillomavirus (HPV) infection and occurrence of cervical cancer has resulted in development of various HPV related control strategies for the prevention of cervical cancer. The objective of the present study was to assess the cost effectiveness of various screening strategies for cervical cancer and human papilloma virus (HPV) vaccination in India. A Markov model based on societal perspective was designed to estimate the lifetime costs and consequences of screening (with either visual inspect with acetic acid (VIA), Papanicolaou test or HPV DNA test at various time intervals) in a hypothetical cohort of 30-65 years age women or vaccination among adolescent girls. Diagnostic accuracy of the screening strategies, efficacy of HPV vaccination and data on transition probabilities was based on the results of the existing meta-analyses. Primary data was collected for assessing per person cost of screening, cost of treating cervical cancer and quality of life. We found that introduction of different screening strategies leads to reduction in lifetime occurrence of cervical cancer cases caused by HPV 16/18 from 20% to 61%, and cervical cancer deaths from 28% to 70%, as compared to no screening. Among various screening strategies, screening with both VIA 5 yearly and VIA 10 yearly came out to be cost effective at 1-time per capita GDP, with VIA every 5 years providing greater health benefits as compared to VIA 10 years. Hence, screening with VIA 5 years at an incremental cost of US$ 829 (INR 54,881) per QALY gained is the recommended strategy for India. Further, with regards to HPV vaccination, it leads to 60% reduction in cancer cases and mortality caused by HPV 16/18 as compared to no vaccination. Moreover, when this vaccinated cohort of adolescent girls is also screened later in their life (with VIA every 10 years and VIA 5 years), it leads to 69%-76% reduction in cancer cases and 71%-81% reduction in cancer deaths. As compared to no vaccination and no screening, both HPV vaccination alone and vaccination plus screening (with VIA every 5 yearly and VIA 10 yearly) appears to be cost effective with ICERs in the range of US$ 86 (INR 5,693) to US$ 476 (INR 31,511) per QALY gained. In the long run, when the cohort of adolescent girls, who were immunized for HPV, reach the age of 30 years, the screening frequency using VIA should be determined based on the coverage of HPV vaccination in that cohort.
Collapse
Affiliation(s)
- Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - JS Malliga
- Department of Preventive Oncology, Cancer Institute (WIA), Adyar, Chennai, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
22
|
Singh MP, Chauhan AS, Rai B, Ghoshal S, Prinja S. Cost of Treatment for Cervical Cancer in India. Asian Pac J Cancer Prev 2020; 21:2639-2646. [PMID: 32986363 PMCID: PMC7779435 DOI: 10.31557/apjcp.2020.21.9.2639] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cervical cancer is a major public health problem in India leading to high economic burden, which is disproportionately borne by the patients as out-of-pocket expenditure (OOPE). Several publicly financed health insurance schemes (PFHIs) in India cover the treatment for cervical cancer. However, the provider payment rates for health benefit packages (HBP) under these PFHIs are not based on scientific evidence. We undertook this study to estimate the cost of services provided for treatment of cervical cancer and cost of the package of care for cervical cancer in India. METHODS The study was undertaken at a large public tertiary hospital in North India. The health system cost was assessed using a mixed micro-costing approach. The data were collected for all the resources utilized during service delivery for cervical cancer patients. To evaluate the OOPE, randomly selected 248 patients were interviewed following the cost of illness approach. Logistic regression was used to assess the factors associated with catastrophic health expenditure (CHE). RESULTS Health system cost for different cervical cancer treatment modalities i.e. radiotherapy, brachytherapy, chemotherapy and surgery, ranges from INR 19,494 to 41,388 (USD 291 - 617). Furthermore, patients spent INR 4,042 to 23,453 ( USD 60 - 350) as OOPE. Nearly 62% patients incurred CHE, and 30% reported distress financing. The odds of CHE (OR: 25.39, p-value: <0.001) and distress financing (OR: 15.37, p-value: 0.001) were significantly higher in poorest-income quintile. The HBP cost varies from INR 45,364 to 64,422 (USD 676 - 960) for brachytherapy and radiotherapy respectively. CONCLUSION Cervical cancer treatment leads to high OOPE in India, which imposes financial hardship, especially for the poorest. The coverage of risk pooling mechanisms like PHFIs should be enhanced. The findings of our study should be used to set the reimbursement rates of providing cervical cancer treatment under PFHI schemes.
Collapse
Affiliation(s)
- Maninder Pal Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Bhavana Rai
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sushmita Ghoshal
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| |
Collapse
|
23
|
Abidi S, Labani S, Singh A, Asthana S, Ajmera P. Economic evaluation of human papillomavirus vaccination in the Global South: a systematic review. Int J Public Health 2020; 65:1097-1111. [PMID: 32712694 DOI: 10.1007/s00038-020-01431-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Many reviews have been conducted on the economic evaluation of the HPV vaccine in global north countries. But there is a dearth of such reviews in the Global South countries. Hence, this systematic review aims to summarize studies done in these countries. METHODS Four databases PubMed, Embase, Cochrane Library, and Google Scholar from 2009 to 2019 were searched for economic evaluations on HPV vaccination in the Global South countries. PRISMA guidelines were followed to include full-text articles. 40 original articles were shortlisted for full-text review. RESULTS Studies had varied models, assumptions, and results according to different scenarios. Most studies concluded HPV vaccination to be cost-effective under varied scenarios and vaccine cost was the most influential parameter affecting the sensitivity analyses, consequently incremental cost-effectiveness ratio. A wide range in the cost-effectiveness ratio was observed in the included studies due to different study settings, populations, and inconsistencies in modeling practices (variations in methodological approaches). CONCLUSIONS This review suggests the introduction of HPV vaccination alone or in combination with screening according to different countries. The price of the vaccine should be economical and funds for the vaccine should be provided by public sector firms.
Collapse
Affiliation(s)
- Saba Abidi
- Delhi Pharmaceutical Sciences and Research University, New Delhi, India.
| | - Satyanarayana Labani
- Indian Council of Medical Research - National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Aastha Singh
- Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Smita Asthana
- Indian Council of Medical Research - National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Puneeta Ajmera
- Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| |
Collapse
|
24
|
Bahuguna P, Prinja S, Lahariya C, Dhiman RK, Kumar MP, Sharma V, Aggarwal AK, Bhaskar R, De Graeve H, Bekedam H. Cost-Effectiveness of Therapeutic Use of Safety-Engineered Syringes in Healthcare Facilities in India. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:393-411. [PMID: 31741306 PMCID: PMC7250963 DOI: 10.1007/s40258-019-00536-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Globally, 16 billion injections are administered each year of which 95% are for curative care. India contributes 25-30% of the global injection load. Over 63% of these injections are reportedly unsafe or deemed unnecessary. OBJECTIVES To assess the incremental cost per quality-adjusted life-year (QALY) gained with the introduction of safety-engineered syringes (SES) as compared to disposable syringes for therapeutic care in India. METHODS A decision tree was used to compute the volume of needle-stick injuries (NSIs) and reuse episodes among healthcare professionals and the patient population. Subsequently, three separate Markov models were used to compute lifetime costs and QALYs for individuals infected with hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Three SES were evaluated-reuse prevention syringe (RUP), sharp injury prevention (SIP) syringe, and syringes with features of both RUP and SIP. A lifetime study horizon starting from a base year of 2017 was considered appropriate to cover all costs and consequences comprehensively. A systematic review was undertaken to assess the SES effects in terms of reduction in NSIs and reuse episodes. These were then modelled in terms of reduction in transmission of blood-borne infections, life-years and QALYs gained. Future costs and consequences were discounted at the rate of 3%. Incremental cost per QALY gained was computed to assess the cost-effectiveness. A probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. RESULTS The introduction of RUP, SIP and RUP + SIP syringes in India is estimated to incur an incremental cost of Indian National Rupee (INR) 61,028 (US$939), INR 7,768,215 (US$119,511) and INR 196,135 (US$3017) per QALY gained, respectively. A total of 96,296 HBV, 44,082 HCV and 5632 HIV deaths are estimated to be averted due to RUP in 20 years. RUP has an 84% probability to be cost-effective at a threshold of per capita gross domestic product (GDP). The RUP syringe can become cost saving at a unit price of INR 1.9. Similarly, SIP and RUP + SIP syringes can be cost-effective at a unit price of less than INR 1.2 and INR 5.9, respectively. CONCLUSION RUP syringes are estimated to be cost-effective in the Indian context. SIP and RUP + SIP syringes are not cost-effective at the current unit prices. Efforts should be made to bring down the price of SES to improve its cost-effectiveness.
Collapse
Affiliation(s)
- Pankaj Bahuguna
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | | | - Radha Krishan Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhumita Prem Kumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vineeta Sharma
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Arun Kumar Aggarwal
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | | | - Hilde De Graeve
- World Health Organization Country Office for India, New Delhi, India
| | - Henk Bekedam
- World Health Organization Country Office for India, New Delhi, India
| |
Collapse
|
25
|
Luo Y, He H, Tang X, Wang S, Zhang J, Wu T, Chen Z. Cost-effectiveness of 2-dose human papillomavirus vaccination for 12-year-old girls in Zhejiang Province: implications for China's expanded program on immunization. Hum Vaccin Immunother 2020; 16:1623-1629. [PMID: 32186953 DOI: 10.1080/21645515.2019.1711299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The high cost and insufficient supply of HPV vaccines have substantially slowed their implementation in lower-income countries. This study aimed to assess the incremental cost-effectiveness of two doses of human papillomavirus (HPV) vaccination (bivalent 16/18 vaccine; 2vHPV) compared to a no-vaccination scenario and a three-dose scenario in one province in China. METHODS A static Markov model was used to model a lifetime cohort of 100,000 girls aged 12 years at the start of vaccination. A two-dose vaccination schedule was assumed to be non-inferior to a three-dose schedule in terms of vaccine efficacy, and both vaccination schemes were assumed to provide lifelong protection. Incremental costs, health effects and incremental cost-effectiveness ratios were used to measure the outcomes when comparing the different strategies. RESULTS Compared to no vaccination, the incremental cost-effectiveness ratio (Chinese yuan per quality-adjusted life year) of the two-dose vaccination strategy is 12,472, and the 2-dose strategy is calculated to be cost saving relative to the 3-dose vaccination strategy. CONCLUSIONS Introducing the 2vHPV vaccine would be highly cost effective at a per-dose vaccine price of CNY 500, which has implications for cervical cancer control in China and other resource-limited countries.
Collapse
Affiliation(s)
- Yan Luo
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen, China
| | - Hanqing He
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Xuewen Tang
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Shenyu Wang
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Jun Zhang
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen, China
| | - Ting Wu
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen, China
| | - Zhiping Chen
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| |
Collapse
|
26
|
Anwari P, Debellut F, Vodicka E, Clark A, Farewar F, Zhwak ZA, Nazary D, Pecenka C, Scott LaMontagne D, Safi N. Potential health impact and cost-effectiveness of bivalent human papillomavirus (HPV) vaccination in Afghanistan. Vaccine 2020; 38:1352-1362. [PMID: 31870571 PMCID: PMC6997884 DOI: 10.1016/j.vaccine.2019.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination has not been introduced in many countries in South-Central Asia, including Afghanistan, despite the sub-region having the highest incidence rate of cervical cancer in Asia. This study estimates the potential health impact and cost-effectiveness of HPV vaccination in Afghanistan to inform national decision-making. METHOD An Excel-based static cohort model was used to estimate the lifetime costs and health outcomes of vaccinating a single cohort of 9-year-old girls in the year 2018 with the bivalent HPV vaccine, compared to no vaccination. We also explored a scenario with a catch-up campaign for girls aged 10-14 years. Input parameters were based on local sources, published literature, or assumptions when no data was available. The primary outcome measure was the discounted cost per disability-adjusted life-year (DALY) averted, evaluated from both government and societal perspectives. RESULTS Vaccinating a single cohort of 9-year-old girls against HPV in Afghanistan could avert 1718 cervical cancer cases, 125 hospitalizations, and 1612 deaths over the lifetime of the cohort. The incremental cost-effectiveness ratio was US$426 per DALY averted from the government perspective and US$400 per DALY averted from the societal perspective. The estimated annual cost of the HPV vaccination program (US$3,343,311) represents approximately 3.53% of the country's total immunization budget for 2018 or 0.13% of total health expenditures. CONCLUSION In Afghanistan, HPV vaccine introduction targeting a single cohort is potentially cost-effective (0.7 times the GDP per capita of $586) from both the government and societal perspective with additional health benefits generated by a catch-up campaign, depending on the government's willingness to pay for the projected health outcomes.
Collapse
Affiliation(s)
- Palwasha Anwari
- Afghanistan National Immunization Technical Advisory Group, District 10, Kabul, Afghanistan
| | | | | | - Andrew Clark
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Farhad Farewar
- Health Economics and Financing Directorate, Ministry of Public Health, Masood Square, District 10, Kabul, Afghanistan
| | - Zubiada A Zhwak
- Kabul University of Medical Sciences "Abu Ali Ibn Sina", Jamal Mena, University Area, District 3, Kabul, Afghanistan
| | - Dastagger Nazary
- Expanded Program on Immunization, Ministry of Public Health, Street 13, Wazir Akbar Khan, District 10, Kabul, Afghanistan
| | - Clint Pecenka
- PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA
| | | | - Najibullah Safi
- World Health Organization, UNOCA Compound, Jalalabad Road, District 9, Kabul, Afghanistan
| |
Collapse
|
27
|
|
28
|
Gupta N, Verma R, Dhiman RK, Rajsekhar K, Prinja S. Cost-Effectiveness Analysis and Decision Modelling: A Tutorial for Clinicians. J Clin Exp Hepatol 2020; 10:177-184. [PMID: 32189934 PMCID: PMC7068010 DOI: 10.1016/j.jceh.2019.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
Cost-effectiveness analysis (CEA) provides information on how much extra do we need to spend per unit gain in health outcomes with introduction of any new healthcare intervention or treatment as compared to the alternative. This information is crucial to make decision regarding funding any new drug, diagnostic test or determining standard treatment protocol. It becomes even more important to consider this evidence in resource constrained low-income and middle-income country settings. Generating evidence on costs and consequences of a treatment or intervention could be performed in the setting of a randomized controlled trial, which is the perfect platform to evaluate efficacy or effectiveness. However, we argue that randomized controlled trial (RCT) offers an incomplete setting to generate comprehensive data on all costs and consequences for the purpose of a CEA. Hence, it is needed to use a decision model, either in combination with the evidence from RCT or alone. In this article, we demonstrate the application of decision model-based economic evaluation using 2 separate techniques - a decision tree and a Markov model. We argue that application of a decision model allows computation of health benefits in terms of utility-based measure such as a quality-adjusted life year or disability-adjusted life year which is preferred for a CEA, measure distal costs and consequences which are much more downstream to the application of intervention, allows comparison with multiple intervention and comparators, and provides opportunity of making use of evidence from multiple sources rather than a single RCT which may have limited generalizability. This makes the use of such evidence much more acceptable for clinical use and policy relevant.
Collapse
Key Words
- BCLC, Barcelona Clinic Liver Cancer
- BSC, Best Supportive Care
- CAD, Coronary Artery Disease
- CEA, Cost-Effectiveness Analysis
- DALY, Disability Adjusted Life Year
- EE, Economic Evaluation
- HCC, Hepatocellular Carcinoma
- HCV, Hepatitis C Virus
- HPV, Human Papillomavirus
- Hib, Hemophilus Influenza
- ICER, Incremental Cost-Effectiveness Ratio
- PD, Progressive Disease
- PFS, Progression-Free State
- QALY, Quality Adjusted Life Year
- RCT, Randomized controlled trial
- SNCU, Special Newborn Care Unit
- cost-effectiveness
- decision model
- decision tree
- economic evaluation
- markov model
Collapse
Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Rohan Verma
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kavitha Rajsekhar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Shankar Prinja, Additional Professor of Health Economics School of Public Health, Post Graduate Institute of Medical Education and Research Sector-12, Chandigarh, 60012, India.
| |
Collapse
|
29
|
Sankaranarayanan R, Basu P, Kaur P, Bhaskar R, Singh GB, Denzongpa P, Grover RK, Sebastian P, Saikia T, Oswal K, Kanodia R, Dsouza A, Mehrotra R, Rath GK, Jaggi V, Kashyap S, Kataria I, Hariprasad R, Sasieni P, Bhatla N, Rajaraman P, Trimble EL, Swaminathan S, Purushotham A. Current status of human papillomavirus vaccination in India's cervical cancer prevention efforts. Lancet Oncol 2019; 20:e637-e644. [PMID: 31674322 DOI: 10.1016/s1470-2045(19)30531-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 01/26/2023]
Abstract
Efforts are being made to scale up human papillomavirus (HPV) vaccination for adolescent girls in India. Bivalent and quadrivalent HPV vaccines were licensed in the country in 2008, and a nonavalent vaccine was licensed in 2018. Demonstration projects initiated in Andhra Pradesh and Gujarat in 2009 introduced HPV vaccination in public health services in India. Following a few deaths in these projects, although subsequently deemed unrelated to vaccination, HPV vaccination in research projects was suspended. This suspension by default resulted in some participants in a trial evaluating two versus three doses receiving only one dose. Since 2016, the successful introduction of HPV vaccination in immunisation programmes in Punjab and Sikkim (with high coverage and safety), government-sponsored opportunistic vaccination in Delhi, prospects of a single dose providing protection, and future availability of an affordable Indian vaccine shows promise for future widespread implementation and evaluation of HPV vaccination in India.
Collapse
Affiliation(s)
- Rengaswamy Sankaranarayanan
- RTI International India, New Delhi, India; International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Partha Basu
- International Agency for Research on Cancer, World Health Organization, Lyon, France.
| | - Prabhdeep Kaur
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Rajesh Bhaskar
- Department of Health and Family Welfare, Government of Punjab, Chandigarh, India
| | - Gurinder Bir Singh
- Department of Health and Family Welfare, Government of Punjab, Chandigarh, India
| | - Phumzay Denzongpa
- Human Services and Family Welfare Department, Government of Sikkim, Gangtok, India
| | | | | | | | | | | | | | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research, Noida, India
| | - Goura Kishor Rath
- National Cancer Institute, All India Institute of Medical Sciences, Jhajjar Campus, Badsa, Haryana, India; Dr B R Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Roopa Hariprasad
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research, Noida, India
| | - Peter Sasieni
- Kings Clinical Trials Unit, King's College London, London, UK
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Preetha Rajaraman
- Office of Global Affairs, Department of Health and Human Services, Washington, DC, USA
| | - Edward L Trimble
- Global HPV and Cervical Cancer Research and Control, National Cancer Institute, Rockville, MD, USA
| | | | - Arnie Purushotham
- King's Health Partners Integrated Cancer Centre, King's College London, London, UK
| |
Collapse
|
30
|
Chugh Y, Dhiman RK, Premkumar M, Prinja S, Singh Grover G, Bahuguna P. Real-world cost-effectiveness of pan-genotypic Sofosbuvir-Velpatasvir combination versus genotype dependent directly acting anti-viral drugs for treatment of hepatitis C patients in the universal coverage scheme of Punjab state in India. PLoS One 2019; 14:e0221769. [PMID: 31465503 PMCID: PMC6715223 DOI: 10.1371/journal.pone.0221769] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023] Open
Abstract
Background We undertook this study to assess the incremental cost per quality adjusted life year (QALY) gained with the use of pan-genotypic sofosbuvir (SOF) + velpatasvir (VEL) for HCV patients, as compared to the current treatment regimen under the universal free treatment scheme in Punjab state. Methodology A Markov model depicting natural history of HCV was developed to simulate the progression of disease. Three scenarios were compared: I (Current Regimen)—use of SOF + daclatasvir (DCV) for non-cirrhotic patients and ledipasvir (LDV) or DCV with SOF ± ribavirin (RBV) according to the genotype for cirrhotic patients; II—use of SOF + DCV for non-cirrhotic patients and use of SOF+VEL for compensated cirrhotic patients (with RBV in decompensated cirrhosis patients) and III—use of SOF+VEL for both non-cirrhotic and compensated cirrhotic patients (with RBV in decompensated cirrhosis patients). The lifetime costs, life-years and QALYs were assessed for each scenario, using a societal perspective. All the future costs and health outcomes were discounted at an annual rate of 3%. Finally, the incremental cost per QALY gained was computed for each of scenario II and III, as compared to scenario I and for scenario III as compared to II. In addition, we evaluated the lifetime costs and QALYs among HCV patients for each of scenario I, II and III against the counterfactual of ‘no universal free treatment scheme’ scenario which involves patients purchasing care in routine setting of from public and private sector. Results Each of the scenarios I, II and III dominate over the no universal free treatment scheme scenario, i.e. have greater QALYs and lesser costs. The use of SOF+VEL only for cirrhotic patients (scenario II) increases QALYs by 0.28 (0.03 to 0.71) per person, and decreases the cost by ₹ 5,946 (₹ 1,198 to ₹ 14,174) per patient, when compared to scenario I. Compared to scenario I, scenario III leads to an increase in QALYs by 0.44 (0.14 to 1.01) per person, and is cost-neutral. While the mean cost difference between scenario III and I is—₹ 2,676 per patient, it ranges from a cost saving of ₹ 14,835 to incurring an extra cost of ₹ 3,456 per patient. For scenario III as compared II, QALYs increase by 0.16 (0.03 to 0.36) per person as well as costs by ₹ 3,086 per patient which ranges from a cost saving of ₹ 1,264 to incurring an extra cost of ₹ 6,344. Shift to scenario II and III increases the program budget by 5.5% and 60% respectively. Conclusion Overall, the use of SOF+VEL is highly recommended for the treatment of HCV infection. In comparison to the current practice (scenario I), scenario II is a dominant option. Scenario III is cost-effective as compared to scenario II at a threshold of one-time GDP per capita. If budget is an important constraint, velpatasvir should be given to HCV infected cirrhotic patients. However, if no budget constraint, universal use of velpatasvir for HCV treatment is recommended.
Collapse
Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha Krishan Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Mukh Mantri Punjab Hepatitis C Relief Fund (MMPHCRF), Punjab Government, Punjab, India
- Technical Resource Group, National Viral Hepatitis Control Program (NVHCP), Government of India, Ministry of Health and Family Welfare, New Delhi, India
| | - Madhumita Premkumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | | | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
31
|
Shetty S, Prabhu S, Shetty V, Shetty AK. Knowledge, attitudes and factors associated with acceptability of human papillomavirus vaccination among undergraduate medical, dental and nursing students in South India. Hum Vaccin Immunother 2019; 15:1656-1665. [PMID: 30648913 DOI: 10.1080/21645515.2019.1565260] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: To evaluate knowledge, attitudes and factors associated with acceptability of human papillomavirus (HPV) vaccine among undergraduate medical, dental, and nursing students in South India. Methods: Using a post-test study design, a convenience sample of 988 students (age 18-26 years) were surveyed. The primary outcome was vaccine acceptability (likely to intend to receive the vaccine). Bivariate analysis using Chi-Square test of independence and multivariate binary logistic regression analysis was used to examine factors associated with vaccine acceptability. Results: Out of 988 students surveyed, majority had heard about cervical cancer (95%), HPV (89.3) or genital warts(77.5). Only 59.7% had heard of HPV vaccine prior to the survey; 65.2% intended to receive the vaccine and 68.3% were willing to recommend the vaccine to others. Participants aged <22 years were less likely to accept the vaccine (OR:0.85, CI:0.76-0.96) compared with participants aged older than 22 years. Medical students (OR:1.12, CI:1.03-1.23), students who reported alcohol use (OR:1.15, CI:1.03-1.29) and those with moderate knowledge scores were more likely to intend to receive the vaccine (OR:1.14, CI:1.04-1.24), compared to others. On multivariate analysis, only course (OR 1.366, CI 1.016-1.835) and attitude score (OR 4.17; CI 2.12-8.2) were statistically associated with intention to receive the HPV vaccine. Conclusion: Two-thirds of students intended to receive the HPV vaccine. Although the overall awareness of the HPV-related disease and prevention is good, considerable knowledge gaps exists in many areas suggesting that that more education about HPV disease and benefits of vaccination should be included in the undergraduate medical school curriculum.
Collapse
Affiliation(s)
- Seemitha Shetty
- a Department of Microbiology, K.S. Hegde Medical Academy (KSHEMA) , Mangaluru , India
| | - Sumathi Prabhu
- b Department of Mathematics, Manipal Institute of Technology , Manipal , India
| | - Veena Shetty
- a Department of Microbiology, K.S. Hegde Medical Academy (KSHEMA) , Mangaluru , India
| | - Avinash K Shetty
- c Department of Pediatrics, Wake Forest School of Medicine and Brenner Children's Hosptial , Winston-Salem , NC , USA
| |
Collapse
|
32
|
Impact and cost effectiveness of pneumococcal conjugate vaccine in India. Vaccine 2019; 37:623-630. [PMID: 30587430 DOI: 10.1016/j.vaccine.2018.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/19/2022]
|
33
|
Cost-effectiveness of Sorafenib for Treatment of Advanced Hepatocellular Carcinoma in India. J Clin Exp Hepatol 2019; 9:468-475. [PMID: 31516263 PMCID: PMC6728525 DOI: 10.1016/j.jceh.2018.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 10/23/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Majority of patients of hepatocellular carcinoma (HCC) in India present in advanced stages, when curative treatment options are limited. We undertook this study to assess the cost-effectiveness of treating advanced HCC patients with sorafenib compared with best supportive care (BSC). METHODS A Markov model was parameterized to model the lifetime costs and consequences of treating advanced HCC patients with sorafenib versus BSC using a societal perspective. Cost of routine care, diagnostics, management of complications in both the arms and management of adverse effects of sorafenib treatment were considered. A probabilistic sensitivity analysis was undertaken to assess the effect of parameter uncertainty. RESULTS The incremental cost and benefit gained by treating HCC using sorafenib was Indian rupees 94,182 ($1459) and 0.19 quality adjusted life years (QALYs) per patient, implying an incremental cost of Indian rupees 507,520 ($7861) per QALY gained. CONCLUSIONS Sorafenib is not cost-effective for use in advanced hepatocellular carcinoma treatment in India.
Collapse
Key Words
- BCLC, Barcelona Clinic Liver Cancer
- BSC, Best Supportive Care
- CEAC, Cost-Effectiveness Acceptability Curve
- CGHS, Central Government Health Scheme
- GDP, Gross Domestic Product
- HBV, Hepatitis B Viral
- HCC, Hepatocellular Carcinoma
- ICER, Incremental Cost-Effectiveness Ratio
- ICU, Intensive Care Unit
- INASL, Indian National Association for Study of Liver
- INR, Indian National Rupees
- LY, Life Year
- PD, Progressive Disease
- PFS, Progression Free State
- PSA, Probabilistic Sensitivity Analysis
- QALY, Quality Adjusted Life Year
- QOL, Quality of Life
- RCC, Renal Cell Carcinoma
- TTSP, Time to Symptomatic Progression
- UGIE, Upper Gastrointestinal Endoscopy
- USD, US Dollars
- cancer
- cost effectiveness analysis
- hepatocellular carcinoma
- sorafenib
Collapse
|
34
|
Cost Effectiveness of Hematopoietic Stem Cell Transplantation Compared with Transfusion Chelation for Treatment of Thalassemia Major. Biol Blood Marrow Transplant 2018; 24:2119-2126. [DOI: 10.1016/j.bbmt.2018.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/02/2018] [Indexed: 01/19/2023]
|
35
|
Prinja S, Balasubramanian D, Jeet G, Verma R, Kumar D, Bahuguna P, Kaur M, Kumar R. Cost of delivering secondary-level health care services through public sector district hospitals in India. Indian J Med Res 2018; 146:354-361. [PMID: 29355142 PMCID: PMC5793470 DOI: 10.4103/ijmr.ijmr_902_15] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. METHODS Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. RESULTS The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was ' 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was ' 844 (USD 15.5), ' 3481 (USD 64) and ' 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was ' 139 (USD 2.5). INTERPRETATION & CONCLUSIONS The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.
Collapse
Affiliation(s)
- Shankar Prinja
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepak Balasubramanian
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Gursimer Jeet
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ramesh Verma
- Department of Community Medicine, Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Dinesh Kumar
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, India
| | - Pankaj Bahuguna
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Manmeet Kaur
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajesh Kumar
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
36
|
Prinja S, Jyani G, Bahuguna P, Faujdar DS, Kumar R. Reply to When flawed modeling justifies cost-effectiveness: Making sense of "Band-Aid" modeling. Cancer 2018; 124:3267-3270. [PMID: 29750834 DOI: 10.1002/cncr.31544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/06/2018] [Accepted: 04/16/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Shankar Prinja
- School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Jyani
- School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharmjeet Singh Faujdar
- School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Kumar
- School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
37
|
Borah BJ, John D, Moriarty JP. When flawed modeling justifies cost-effectiveness: Making sense of "Band-Aid" modeling. Cancer 2018; 124:3266-3267. [PMID: 29750832 DOI: 10.1002/cncr.31545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/16/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Bijan J Borah
- Health Services Research, Mayo Clinic College of Medicine;, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | - Denny John
- Campbell Collaboration, New Delhi, India
| | - James P Moriarty
- Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
38
|
Prinja S, Bahuguna P, Gupta A, Nimesh R, Gupta M, Thakur JS. Cost effectiveness of mHealth intervention by community health workers for reducing maternal and newborn mortality in rural Uttar Pradesh, India. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:25. [PMID: 29983645 PMCID: PMC6020234 DOI: 10.1186/s12962-018-0110-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 06/13/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A variety of mobile-based health technologies (mHealth) have been developed for use by community health workers to augment their performance. One such mHealth intervention-ReMiND program, was implemented in a poor performing district of India. Despite some research on the extent of its effectiveness, there is significant dearth of evidence on cost-effectiveness of such mHealth interventions. In this paper we evaluated the incremental cost per disability adjusted life year (DALY) averted as a result of ReMiND intervention as compared to routine maternal and child health programs without ReMiND. METHODS A decision tree was parameterized on MS-Excel spreadsheet to estimate the change in DALYs and cost as a result of implementing ReMiND intervention compared with routine care, from both health system and societal perspective. A time horizon of 10 years starting from base year of 2011 was considered appropriate to cover all costs and effects comprehensively. All costs, including those during start-up and implementation phase, besides other costs on the health system or households were estimated. Consequences were measured as part of an impact assessment study which used a quasi-experimental design. Proximal outputs in terms of changes in service coverage were modelled to estimate maternal and infant illnesses and deaths averted, and DALYs averted in Uttar Pradesh state of India. Probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. RESULTS Cumulatively, from year 2011 to 2020, implementation of ReMiND intervention in UP would result in a reduction of 312 maternal and 149,468 neonatal deaths. This implies that ReMiND program led to a reduction of 0.2% maternal and 5.3% neonatal deaths. Overall, ReMiND is a cost saving intervention from societal perspective. From health system perspective, ReMiND incurs an incremental cost of INR 12,993 (USD 205) per DALY averted and INR 371,577 (USD 5865) per death averted. CONCLUSIONS Overall, findings of our study suggest strongly that the mHealth intervention as part of ReMiND program is cost saving from a societal perspective and should be considered for replication elsewhere in other states.
Collapse
Affiliation(s)
- Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Pankaj Bahuguna
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Aditi Gupta
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Ruby Nimesh
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Madhu Gupta
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Jarnail Singh Thakur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| |
Collapse
|
39
|
Sabeena S, Bhat PV, Kamath V, Arunkumar G. Global human papilloma virus vaccine implementation: An update. J Obstet Gynaecol Res 2018. [PMID: 29517117 DOI: 10.1111/jog.13634] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Human papillomavirus (HPV) infections continue to be one of the most common sexually transmitted infections worldwide. The oncogenic potential of this virus was well established in anogenital malignancies and oropharyngeal cancers. Even though a fall in cervical cancer rates has been reported worldwide, the subsequent rise in HPV-associated head and neck cancers among men and women have been reported from developed countries, necessitating the vaccination of adolescent boys as well. The objective of this narrative review is to provide an update on the current status of HPV vaccination worldwide. This will be helpful for clinicians in counseling parents and guardians as this vaccine mainly targets sexually naïve preadolescents. An electronic search of the databases was carried out to retrieve information concerning HPV vaccine implementation between July 2006 and 2017, with special emphasis on the current viewpoints, controversies and ethical issues. Globally, 74 countries have implemented the HPV vaccine in the national immunization schedule, and this vaccine is listed as an essential medicine by WHO. About 60% of the low- and lower-middle-income countries have implemented the vaccine with financial assistance from Gavi and WHO. The HPV vaccine is a safe vaccine with no serious adverse effects as per the data available from developed nations as well as low/lower middle/upper middle-income countries. However, long-term follow-up is essential to substantiate the impact of the vaccination programs in cancer prevention.
Collapse
Affiliation(s)
- Sasidharanpillai Sabeena
- Manipal Centre for Virus Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Parvati V Bhat
- Department of Obstetrics and Gynecology, Dr TMA Pai Hospital, MMMC, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Veena Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | |
Collapse
|
40
|
Prinja S, Bahuguna P, Faujdar DS, Jyani G, Srinivasan R, Ghoshal S, Suri V, Singh MP, Kumar R. Reply to The Reply to the letter on the cost-effectiveness of human papillomavirus in Punjab further distorts the scientific record. Cancer 2018; 124:1085-1086. [PMID: 29323704 DOI: 10.1002/cncr.31226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Shankar Prinja
- School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharmjeet Singh Faujdar
- School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Jyani
- School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Gynaecology and Obstetrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P Singh
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Kumar
- School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
41
|
Prinja S, Downey LE, Gauba VK, Swaminathan S. Health Technology Assessment for Policy Making in India: Current Scenario and Way Forward. PHARMACOECONOMICS - OPEN 2018; 2:1-3. [PMID: 29464668 PMCID: PMC5820238 DOI: 10.1007/s41669-017-0037-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Laura E Downey
- Global Health and Development, Imperial College London, St Mary's Campus, London, W2 1NY, UK
| | - Vijay K Gauba
- Department of Health Research (DHR), Ministry of Health and Family Welfare, New Delhi, India
| | - Soumya Swaminathan
- Department of Health Research (DHR), Ministry of Health and Family Welfare, New Delhi, India
- Indian Council of Medical Research (ICMR), New Delhi, India
| |
Collapse
|
42
|
Suman V, Puliyel JM. The Reply to the letter on the cost-effectiveness of human papillomavirus in Punjab further distorts the scientific record. Cancer 2018; 124:1085. [PMID: 29165797 DOI: 10.1002/cncr.31167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Vivian Suman
- Department of Pediatrics, St. Stephens Hospital, Delhi, India
| | - Jacob M Puliyel
- Department of Pediatrics, St. Stephens Hospital, Delhi, India
| |
Collapse
|
43
|
Suman V, Puliyel JM. Cost-effectiveness calculations of human papillomavirus vaccination in Punjab may be flawed. Cancer 2018; 124:213-214. [PMID: 29044492 DOI: 10.1002/cncr.31075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/13/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Vivian Suman
- Department of Pediatrics, St Stephens Hospital, Delhi, India
| | - Jacob M Puliyel
- Department of Pediatrics, St Stephens Hospital, Delhi, India
| |
Collapse
|
44
|
Prinja S, Bahuguna P, Faujdar DS, Jyani G, Srinivasan R, Ghoshal S, Suri V, Singh MP, Kumar R. Reply to Cost-effectiveness calculations of human papillomavirus vaccination in Punjab may be flawed. Cancer 2018; 124:214-216. [PMID: 29044490 DOI: 10.1002/cncr.31074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Shankar Prinja
- School of Public Health Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- School of Public Health Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharamjeet Singh Faujdar
- School of Public Health Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Jyani
- School of Public Health Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Gynaecology and Obstetrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Kumar
- School of Public Health Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|