1
|
Tefera BB, Demsie DG, Yehualaw A, Tafere C, Feyisa K, Yismaw MB, Kefale B, Yilma Z. Characteristics and Quality Appraisal of the Economic Evaluations Done in Ethiopia: A Systematic Review. PHARMACOECONOMICS - OPEN 2023; 7:877-886. [PMID: 37624553 PMCID: PMC10721755 DOI: 10.1007/s41669-023-00433-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Health economic evaluation identifies, measures, values, and compares alternative strategies to efficiently allocate scarce resources. The validity, methodological quality, and generalizability of economic evaluations must be assessed, as poorly designed studies can lead to incorrect conclusions. Therefore, this study aimed to evaluate the quality and characteristics of published economic evaluations done in Ethiopia, using the Quality of Health Economics Studies (QHES) and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) instruments. METHODOLOGY Various electronic databases were searched using different keywords. We included only original studies conducted in Ethiopia that evaluated the cost and consequences of at least two health interventions. Abstracts, treatment guidelines, reviews, expert opinions, and studies that included other countries were excluded. Two reviewers independently evaluated each study using the QHES and CHEERS instruments and any disagreements were then resolved by a third reviewer. RESULT The study included 21 studies published between 2002 and 2021. HIV was the most frequently evaluated medical condition, examined in four (19.06%) of the 21 studies. Seventeen of the studies (80.95%) compared healthcare services or programs, while the other four examined pharmaceutical products. Cost-utility analysis was the economic evaluation technique used in 14 studies (66.67%). Of the studies that disclosed their funding sources, foreign institutions were involved in funding 71.43% of them. Disability-adjusted life-year (DALY) was an outcome metric used in nine (42.86%) studies. The average QHES score of the studies was 82%. Fourteen studies had QHES scores of ≥75% and two had scores of <50%. The studies evaluated using the CHEERS instrument ranged in quality from 42.9% to 92.9%, with an average of 78.23%. CONCLUSION Our study revealed that Ethiopia lacks health economic evaluations, particularly on non-communicable diseases. This indicates that the economic evaluation of healthcare interventions in Ethiopia is still in its early stages. Additionally, Ethiopian institutions have played a very limited role in funding research, highlighting the importance of active participation from local institutions.
Collapse
Affiliation(s)
| | | | - Adane Yehualaw
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Chernet Tafere
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Kebede Feyisa
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | | | - Belayneh Kefale
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Zewdu Yilma
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| |
Collapse
|
2
|
Levin A, Burgess C, Shendale S, Morgan W, Cw Hutubessy R, Jit M. Cost-effectiveness of measles and rubella elimination in low-income and middle-income countries. BMJ Glob Health 2023; 8:e011526. [PMID: 37429697 PMCID: PMC10335502 DOI: 10.1136/bmjgh-2022-011526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/10/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Since 2000, the incidence of measles and rubella has declined as measles-rubella (MR) vaccine coverage increased due to intensified routine immunisation (RI) and supplementary immunisation activities (SIAs). The World Health Assembly commissioned a feasibility assessment of eliminating measles and rubella. The objective of this paper is to present the findings of cost-effectiveness analysis (CEA) of ramping up MR vaccination with a goal of eliminating transmission in every country. METHODS We used projections of impact of routine and SIAs during 2018-2047 for four scenarios of ramping up MR vaccination. These were combined with economic parameters to estimate costs and disability-adjusted life years averted under each scenario. Data from the literature were used for estimating the cost of increasing routine coverage, timing of SIAs and introduction of rubella vaccine in countries. RESULTS The CEA showed that all three scenarios with ramping up coverage above the current trend were more cost-effective in most countries than the 2018 trend for both measles and rubella. When the measles and rubella scenarios were compared with each other, the most cost-effective scenario was likely to be the most accelerated one. Even though this scenario is costlier, it averts more cases and deaths and substantially reduces the cost of treatment. CONCLUSIONS The Intensified Investment scenario is likely the most cost-effective of the vaccination scenarios evaluated for reaching both measles and rubella disease elimination. Some data gaps on costs of increasing coverage were identified and future efforts should focus on filling these gaps.
Collapse
Affiliation(s)
- Ann Levin
- Levin & Morgan LLC, Bethesda, Maryland, USA
| | | | | | | | | | - Mark Jit
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
3
|
Baek Y, Ademi Z, Fisher J, Tran T, Owen A. Equity in Economic Evaluations of Early Childhood Development Interventions in Low-and Middle-Income Countries: Scoping Review. Matern Child Health J 2023; 27:1009-1029. [PMID: 37036566 PMCID: PMC10160157 DOI: 10.1007/s10995-023-03650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES This study aimed to examine how equity is integrated into economic evaluations of early childhood development interventions in low-and middle-income countries (LMICs), and to narratively synthesize the study characteristics and findings. METHODS We conducted a scoping review by searching three electronic databases with terms including equity, early childhood development intervention, economic evaluation, and LMICs. Interventions that aimed to improve child cognitive, physical, language, motor, or social and emotional development through health, nutrition, security and safety, responsive caregiving, and early learning interventions between conception and age 8 years were considered. Studies published in English peer-reviewed journals in the year 2000 and later were included. RESULTS The review included 24 cost-effectiveness studies out of 1460 identified articles based on eligibility criteria. The included studies addressed health, nutrition, social protection, and water, sanitation and hygiene interventions for child development. The common type of intervention was immunization. Mostly, equity was measured using household wealth or geographic areas, and the study findings were presented through subgroup analyses. The study settings were LMICs, but most studies were conducted by research teams from high-income countries. Overall, 63% of included studies reported that early childhood development interventions improved equity with greater intervention benefits observed in disadvantaged groups. CONCLUSIONS Consideration of equity in evaluations of early childhood interventions provides a more complete picture of cost-effectiveness, and can improve equity. Greater focus on promoting equity consideration, multi-sectoral interventions, and researchers in LMICs would support evidence-based interventions and policies to achieve equity in child development.
Collapse
Affiliation(s)
- Yeji Baek
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| |
Collapse
|
4
|
Patikorn C, Cho JY, Lambach P, Hutubessy R, Chaiyakunapruk N. Equity-Informative Economic Evaluations of Vaccines: A Systematic Literature Review. Vaccines (Basel) 2023; 11:622. [PMID: 36992206 PMCID: PMC10057152 DOI: 10.3390/vaccines11030622] [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: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023] Open
Abstract
The Immunization Agenda 2030 prioritizes the populations without access to vaccines. Health equity has been increasingly incorporated into economic evaluations of vaccines to foster equitable access. Robust and standardized methods are needed to evaluate the health equity impact of vaccination programs to ensure monitoring and effective addressing of inequities. However, methods currently in place vary and potentially affect the application of findings to inform policy decision-making. We performed a systematic review by searching PubMed, Embase, Econlit, and the CEA Registry up to 15 December 2022 to identify equity-informative economic evaluations of vaccines. Twenty-one studies were included that performed health equity impact analysis to estimate the distributional impact of vaccines, such as deaths averted and financial risk protection, across equity-relevant subgroups. These studies showed that the introduction of vaccines or improved vaccination coverage resulted in fewer deaths and higher financial risk benefits in subpopulations with higher disease burdens and lower vaccination coverage-particularly poorer income groups and those living in rural areas. In conclusion, methods to incorporate equity have been evolving progressively. Vaccination programs can enhance equity if their design and implementation address existing inequities in order to provide equitable vaccination coverage and achieve health equity.
Collapse
Affiliation(s)
- Chanthawat Patikorn
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10540, Thailand
| | - Jeong-Yeon Cho
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, 1211 Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, 1211 Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84112, USA
| |
Collapse
|
5
|
Erku D, Mersha AG, Ali EE, Gebretekle GB, Wubshet BL, Kassie GM, Mulugeta A, Mekonnen AB, Eshetie TC, Scuffham P. A Systematic Review of Scope and Quality of Health Economic Evaluations Conducted in Ethiopia. Health Policy Plan 2022; 37:514-522. [PMID: 35266523 PMCID: PMC9128743 DOI: 10.1093/heapol/czac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/16/2021] [Accepted: 02/20/2022] [Indexed: 11/13/2022] Open
Abstract
There has been an increased interest in health technology assessment and economic evaluations for health policy in Ethiopia over the last few years. In this systematic review, we examined the scope and quality of healthcare economic evaluation studies in Ethiopia. We searched seven electronic databases (PubMed/MEDLINE, EMBASE, PsycINFO, CINHAL, Econlit, York CRD databases and CEA Tufts) from inception to May 2021 to identify published full health economic evaluations of a health-related intervention or programme in Ethiopia. This was supplemented with forward and backward citation searches of included articles, manual search of key government websites, the Disease Control Priorities-Ethiopia project and WHO-CHOICE programme. The quality of reporting of economic evaluations was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The extracted data were grouped into subcategories based on the subject of the economic evaluation, organized into tables and reported narratively. This review identified 34 full economic evaluations conducted between 2009 and 2021. Around 14 (41%) of studies focussed on health service delivery, 8 (24%) on pharmaceuticals, vaccines and devices, and 4 (12%) on public-health programmes. The interventions were mostly preventive in nature and focussed on communicable diseases (n = 19; 56%) and maternal and child health (n = 6; 18%). Cost-effectiveness ratios varied widely from cost-saving to more than US $37 313 per life saved depending on the setting, perspectives, types of interventions and disease conditions. While the overall quality of included studies was judged as moderate (meeting 69% of CHEERS checklist), only four out of 27 cost-effectiveness studies characterized heterogeneity. There is a need for building local technical capacity to enhance the design, conduct and reporting of health economic evaluations in Ethiopia.
Collapse
Affiliation(s)
- Daniel Erku
- Centre for Applied Health Economics, Griffith University, Nathan, QLD
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
- Addis Consortium for Health Economics and Outcomes Research (AnCHOR)
| | - Amanual G Mersha
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Eskindir Eshetu Ali
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University
| | - Gebremedhin B Gebretekle
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Befikadu L Wubshet
- Health Services Research Centre Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Gizat Molla Kassie
- University of South Australia: Clinical & Health Sciences, Quality Use of Medicines and Pharmacy Research Centre
| | - Anwar Mulugeta
- Australian Centre for Precision Health, Unit of Clinical and Health Sciences, University of South Australia, Adelaide, Australia, SA 5000, Australia
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa 1000, Ethiopia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Alemayehu B Mekonnen
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, VIC, Australia
| | - Tesfahun C Eshetie
- Plein Center for Geriatric Pharmacy Research, Education and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, Nathan, QLD
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
| |
Collapse
|
6
|
OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:686-693. [DOI: 10.1093/trstmh/trac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/17/2021] [Accepted: 02/13/2022] [Indexed: 11/13/2022] Open
|
7
|
Ward T, Mujica-Mota RE, Spencer AE, Medina-Lara A. Incorporating Equity Concerns in Cost-Effectiveness Analyses: A Systematic Literature Review. PHARMACOECONOMICS 2022; 40:45-64. [PMID: 34713423 DOI: 10.1007/s40273-021-01094-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to review analytical methods that enable the incorporation of equity concerns within economic evaluation. METHODS A systematic search of PubMed, Embase, and EconLit was undertaken from database inception to February 2021. The search was designed to identify methodological approaches currently employed to evaluate health-related equity impacts in economic evaluation studies of healthcare interventions. Studies were eligible if they described or elaborated on a formal quantitative method used to integrate equity concerns within economic evaluation studies. Cost-utility, cost-effectiveness, cost-benefit, cost-minimisation, and cost-consequence analyses, as well as health technology appraisals, budget impact analyses, and any relevant literature reviews were included. For each of the identified methods, we provided summaries of the scope of equity considerations covered, the methods employed and their key attributes, data requirements, outcomes, and strengths and weaknesses. A traffic light assessment of the practical suitability of each method was undertaken, alongside a worked example applying the different methods to evaluate the same decision problem. Finally, the review summarises the typical trade-offs arising in cost-effectiveness analyses and discusses the extent to which the evaluation methods are able to capture these. RESULTS In total, 68 studies were included in the review. Methods could broadly be grouped into equity-based weighting (EBW) methods, extended cost-effectiveness analysis (ECEA), distributional cost-effectiveness analysis (DCEA), multi-criteria decision analysis (MCDA), and mathematical programming (MP). EBW and MP methods enable equity consideration through adjustment to incremental cost-effectiveness ratios, whereas equity considerations are represented through financial risk protection (FRP) outcomes in ECEA, social welfare functions (SWFs) in DCEA, and scoring/ranking systems in MCDA. The review identified potential concerns for EBW methods and MCDA with respect to data availability and for EBW methods and MP with respect to explicitly measuring changes in inequality. The only potential concern for ECEA related to the use of FRP metrics, which may not be relevant for all healthcare systems. In contrast, DCEA presented no significant concerns but relies on the use of SWFs, which may be unfamiliar to some audiences and requires societal preference elicitation. Consideration of typical cost-effectiveness and equity-related trade-offs highlighted the flexibility of most methods with respect to their ability to capture such trade-offs. Notable exceptions were trade-offs between quality of life and length of life, for which we found DCEA and ECEA unsuitable, and the assessment of lost opportunity costs, for which we found only DCEA and MP to be suitable. The worked example demonstrated that each method is designed with fundamentally different analytical objectives in mind. CONCLUSIONS The review emphasises that some approaches are better suited to particular decision problems than others, that methods are subject to different practical requirements, and that significantly different conclusions can be observed depending on the choice of method and the assumptions made. Further, to fully operationalise these frameworks, there remains a need to develop consensus over the motivation for equity assessment, which should necessarily be informed with stakeholder involvement. Future research of this topic should be a priority, particularly within the context of equity evaluation in healthcare policy decisions.
Collapse
Affiliation(s)
- Thomas Ward
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, UK.
- College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Ruben E Mujica-Mota
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, UK
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Antonieta Medina-Lara
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
8
|
Does support to Private Health Practitioners increase childhood vaccination coverage? Findings from a comparative study in Afghanistan. Vaccine 2021; 39:5007-5014. [PMID: 34325933 DOI: 10.1016/j.vaccine.2021.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/22/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION In Afghanistan coverage of childhood vaccinations is very low, especially in remote and insecure areas with a weak public health structure. Private health providers (PHPs) in these areas play an important role in health care provision, some of whom have received (para)medical training. In 2009 HealthNet TPO initiated a Public-Private Partnership program in Uruzgan province, training and equipping 34 PHPs in remote and conflict-affected locations to provide quality childhood vaccination services. We aimed to assess the impact of this program on child vaccination coverage. METHODS A cross-sectional household survey was performed in three districts of Uruzgan Province from January through April 2013. A stratified cluster sampling approach was used to select villages; in each of the villages 15 households were randomly selected. Vaccination information, based on vaccination cards and mother's recall, was obtained about all children aged 12-23 months in these households. RESULTS In total 113 children from 8 PHP villages and 286 children from 18 non-PHP villages were included. A clustered analysis showed that coverage of polio-3, diphtheria-tetanus-pertussis (DTP)-3 and of measles-1 were significantly higher in PHP villages (73.5%, 66.4% and 69.9% respectively) than in non-PHP villages (36.0%, 5.2% and 26.2% respectively; P < 0.0001 for all comparisons). The proportion of children being fully vaccinated (excluding BCG) was 54.9% in the PHP villages and 4.9% in the non-PHP villages (P < 0.0001). Vaccinated children in non-PHP villages were mainly vaccinated during mass vaccination campaigns (92.5%), while in PHP villages this was done by PHPs (47.2%) or a combination of PHPs and mass vaccination campaigns (39.2%). CONCLUSION Our study shows that PHPs in remote and conflict affected locations in Afghanistan can play an important role to increase childhood vaccination coverage. Expanding this program to comparable provinces in Afghanistan and to other countries struggling with insecurity and weak public health systems may save much childhood morbidity and mortality.
Collapse
|
9
|
Kauffmann F, Heffernan C, Meurice F, Ota MOC, Vetter V, Casabona G. Measles, mumps, rubella prevention: how can we do better? Expert Rev Vaccines 2021; 20:811-826. [PMID: 34096442 DOI: 10.1080/14760584.2021.1927722] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Measles, mumps, and rubella incidence decreased drastically following vaccination programs' implementation. However, measles and mumps' resurgence was recently reported, outbreaks still occur, and challenges remain to control these diseases. AREAS COVERED This qualitative narrative review provides an objective appraisal of the literature regarding current challenges in controlling measles, mumps, rubella infections, and interventions to address them. EXPERT OPINION While vaccines against measles, mumps, and rubella (including trivalent vaccines) are widely used and effective, challenges to control these diseases are mainly related to insufficient immunization coverage and changing vaccination needs owing to new global environment (e.g. traveling, migration, population density). By understanding disease transmission peculiarities by setting, initiatives are needed to optimize vaccination policies and increase vaccination coverage, which was further negatively impacted by COVID-19 pandemic. Also, awareness of the potential severity of infections and the role of vaccines should increase. Reminder systems, vaccination of disadvantaged, high-risk and difficult-to-reach populations, accessibility of vaccination, healthcare infrastructure, and vaccination services management should improve. Outbreak preparedness should be strengthened, including implementation of high-quality surveillance systems to monitor epidemiology. While the main focus should be on these public health initiatives to increase vaccination coverage, slightly more benefits could come from evolution of current vaccines.
Collapse
Affiliation(s)
| | - Catherine Heffernan
- NHS England (London Region), 1st Floor, Wellington House, 133-155 Waterloo Road, London, SE16UG, UK
| | - François Meurice
- GSK, Avenue Fleming 20, 1300 Wavre, Belgium.,Biomedical Sciences Department, Faculty of Medicine, University of Namur (UNamur), Rue de Bruxelles 61, 5000 Namur, Belgium
| | | | | | | |
Collapse
|
10
|
Nandi A, Shet A. Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Hum Vaccin Immunother 2020; 16:1900-1904. [PMID: 31977283 PMCID: PMC7482790 DOI: 10.1080/21645515.2019.1708669] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The direct benefits of childhood vaccination in reducing the burden of disease morbidity and mortality in a cost-effective manner are well-established. By preventing episodes of vaccine-preventable diseases, vaccination can also help avert associated out-of-pocket medical expenses, healthcare provider costs, and losses in wages of patients and caregivers. Studies have associated vaccines positively with cognition and school attainment, suggesting benefits of long-term improved economic productivity. New evidence suggests that the measles vaccine may improve immunological memory and prevent co-infections, thereby forming a protective shield against other infections, and consequently improving health, cognition, schooling and productivity outcomes well into the adolescence and adulthood in low-income settings. Systematically documenting these broader health, economic, and child development benefits of vaccines is important from a policy perspective, not only in low and middle-income countries where the burden of vaccine-preventable diseases is high and public resources are constrained, but also in high-income settings where the emergence of vaccine hesitancy poses a threat to benefits gained from reducing vaccine-preventable diseases. In this paper, we provide a brief summary of the recent evidence on the benefits of vaccines, and discuss the policy implications of these findings.
Collapse
Affiliation(s)
- Arindam Nandi
- Center for Disease Dynamics, Economics & Policy , Washington, DC, USA
| | - Anita Shet
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| |
Collapse
|
11
|
Ozawa S, Yemeke TT, Thompson KM. Systematic review of the incremental costs of interventions that increase immunization coverage. Vaccine 2018; 36:3641-3649. [PMID: 29754699 PMCID: PMC7853081 DOI: 10.1016/j.vaccine.2018.05.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 01/25/2023]
Abstract
Achieving and maintaining high vaccination coverage requires investments, but the costs and effectiveness of interventions to increase coverage remain poorly characterized. We conducted a systematic review of the literature to identify peer-reviewed studies published in English that reported interventions aimed at increasing immunization coverage and the associated costs and effectiveness of the interventions. We found limited information in the literature, with many studies reporting effectiveness estimates, but not providing cost information. Using the available data, we developed a cost function to support future programmatic decisions about investments in interventions to increase immunization coverage for relatively low and high-income countries. The cost function estimates the non-vaccine cost per dose of interventions to increase absolute immunization coverage by one percent, through either campaigns or routine immunization. The cost per dose per percent increase in absolute coverage increased with higher baseline coverage, demonstrating increasing incremental costs required to reach higher coverage levels. Future studies should evaluate the performance of the cost function and add to the database of available evidence to better characterize heterogeneity in costs and generalizability of the cost function.
Collapse
Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | | |
Collapse
|
12
|
Lal A, Moodie M, Peeters A, Carter R. Inclusion of equity in economic analyses of public health policies: systematic review and future directions. Aust N Z J Public Health 2017; 42:207-213. [PMID: 28898490 DOI: 10.1111/1753-6405.12709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 05/01/2016] [Accepted: 06/01/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To assess current approaches to inclusion of equity in economic analysis of public health interventions and to recommend best approaches and future directions. METHODS We conducted a systematic review of studies that have used socioeconomic position (SEP) in cost-effectiveness analyses. Studies were identified using MedLine, EconLit and HEED and were evaluated based on their SEP specific inputs and methods of quantification of the health and financial inequalities. RESULTS Twenty-nine relevant studies were identified. The majority of studies comparing two or more interventions left interpretation of the size of the health and financial inequality differences to the reader. Newer approaches include: i) use of health inequality measures to quantify health inequalities; ii) inclusion of financial impacts, such as out-of-pocket expenditures; and iii) use of equity weights. The challenge with these approaches is presenting results that policy makers can easily interpret. CONCLUSIONS Using CEA techniques to generate new information about the health equity implications of alternative policy options has not been widely used, but should be considered to inform future decision making. Implications for public health: Inclusion of equity in economic analysis would facilitate a more nuanced comparison of interventions in relation to efficiency, equity and financial impact.
Collapse
Affiliation(s)
- Anita Lal
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Victoria
| | - Marjory Moodie
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Victoria
| | - Anna Peeters
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Victoria
| | - Rob Carter
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Victoria
| |
Collapse
|
13
|
Zhang RQ, Li HB, Li FY, Han LX, Xiong YM. Epidemiological characteristics of measles from 2000 to 2014: Results of a measles catch-up vaccination campaign in Xianyang, China. J Infect Public Health 2017; 10:624-629. [PMID: 28254459 DOI: 10.1016/j.jiph.2017.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/21/2017] [Accepted: 02/04/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rong-Qiang Zhang
- School of Public Health, Shaanxi University of Chinese Medicine, Shiji Road, Xianyang, Shaanxi 712046, PR China; Institute of Endemic Diseases of School of Public Health, Health Science Center, Xi'an Jiaotong University; Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education; Key Laboratory of Trace Elements and Endemic Diseases of Ministry of Health, Xi'an, Shaanxi 710061, PR China
| | - Hong-Bing Li
- Center for Disease Control and Prevention of Baoji City, Shaanxi 721006, PR China
| | - Feng-Ying Li
- Center for Disease Control and Prevention of Xianyang City, Shaanxi 712046, PR China
| | - Li-Xin Han
- Institute of Endemic Diseases of School of Public Health, Health Science Center, Xi'an Jiaotong University; Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education; Key Laboratory of Trace Elements and Endemic Diseases of Ministry of Health, Xi'an, Shaanxi 710061, PR China
| | - Yong-Min Xiong
- Institute of Endemic Diseases of School of Public Health, Health Science Center, Xi'an Jiaotong University; Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education; Key Laboratory of Trace Elements and Endemic Diseases of Ministry of Health, Xi'an, Shaanxi 710061, PR China.
| |
Collapse
|