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Liang Y, Lin Y, Jiao B. Health Interventions May Have Divergent Impacts on Health and Economic Equity: A Case Study of the Community-Based Hypertension Improvement Project in Ghana. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:353-362. [PMID: 38267804 DOI: 10.1007/s40258-024-00871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Improving health and economic equity are key objectives in priority setting, particularly in low-income and middle-income countries. This study aims to assess the distributional impacts of the Community-based Hypertension Improvement Project (ComHIP) on health and economic outcomes across wealth quintiles in Ghana. METHODS We developed a decision analytical model to simulate a 30 million cohort of Ghanaians aged 15-49 years. The study specified health outcomes as the prevention of stroke cases and averting deaths among those with hypertension. Furthermore, we explored economic impacts, including savings in out-of-pocket costs for stroke patients and government spending. Financial risk protection against catastrophic and impoverishing health expenditures was also examined. We assessed these outcomes across wealth quintiles, and the corresponding concentration indexes (CIXs) were determined. RESULTS It was estimated that ComHIP could prevent 1450 stroke cases and 564 related deaths annually. Health benefits were observed to be more significant among the wealthier quintiles (CIX 0.217), mainly attributed to a higher occurrence of hypertension within these groups. ComHIP was also projected to result in an annual saving of USD 49,885 in individuals' out-of-pocket costs (CIX 0.262) and USD 37,578 in government spending (CIX 0.146). These savings correspond to the prevention of 335 catastrophic health expenditure cases (CIX - 0.239) and 11 impoverishing health expenditure cases (CIX - 0.600). CONCLUSIONS While ComHIP provides greater health benefits to wealthier groups, it offers substantial financial risk protection for the less wealthy. This study highlights the importance of considering equity in both health and financial risk when making priority-setting decisions.
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Affiliation(s)
- Yizhi Liang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA
| | - Yuqian Lin
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA
| | - Boshen Jiao
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA.
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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.
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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.
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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.
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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
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LeFevre AE, Mendiratta J, Jo Y, Chamberlain S, Ummer O, Miller M, Scott K, Shah N, Chakraborty A, Godfrey A, Dutt P, Mohan D. Cost-effectiveness of a direct to beneficiary mobile communication programme in improving reproductive and child health outcomes in India. BMJ Glob Health 2023; 6:bmjgh-2022-009553. [PMID: 36958740 PMCID: PMC10175950 DOI: 10.1136/bmjgh-2022-009553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/18/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Kilkari is the largest maternal messaging programme of its kind globally. Between its initiation in 2012 in Bihar and its transition to the government in 2019, Kilkari was scaled to 13 states across India and reached over 10 million new and expectant mothers and their families. This study aims to determine the cost-effectiveness of exposure to Kilkari as compared with no exposure across 13 states in India. METHODS The study was conducted from a programme perspective using an analytic time horizon aligned with national scale-up efforts from December 2014 to April 2019. Economic costs were derived from the financial records of implementing partners. Data on incremental changes in the practice of reproductive maternal newborn and child health (RMNCH) outcomes were drawn from an individually randomised controlled trial in Madhya Pradesh and inputted into the Lives Saved Tool to yield estimates of maternal and child lives saved. One-way and probabilistic sensitivity analyses were carried out to assess uncertainty. RESULTS Inflation adjusted programme costs were US$8.4 million for the period of December 2014-April 2019, corresponding to an average cost of US$264 298 per year of implementation in each state. An estimated 13 842 lives were saved across 13 states, 96% among children and 4% among mothers. The cost per life saved ranged by year of implementation and with the addition of new states from US$392 ($385-$393) to US$953 ($889-$1092). Key drivers included call costs and incremental changes in coverage for key RMNCH practices. CONCLUSION Kilkari is highly cost-effective using a threshold of India's national gross domestic product of US$1998. Study findings provide important evidence on the cost-effectiveness of a national maternal messaging programme in India. TRIAL REGISTRATION NCT03576157.
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Affiliation(s)
- Amnesty Elizabeth LeFevre
- Division of Public Health Medicine, University of Cape Town, School of Public Health, Cape Town, Western Cape, South Africa
| | | | - Youngji Jo
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Sara Chamberlain
- BBC Media Action-India, Delhi, India
- Independent Consultant, Digital Health & Gender, Delhi, India
| | | | - Molly Miller
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kerry Scott
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neha Shah
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arpita Chakraborty
- Research & Evidence, Oxford Policy Management, India, New Delhi, Delhi, India
| | | | - Priyanka Dutt
- BBC Media Action-India, Delhi, India
- GivingTuesday India Hub, Delhi, India
| | - Diwakar Mohan
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Dhaliwal BK, Rattani A, Chandrashekhar R, Bloom DE, Shet A, Seth R. Caregiver perceptions of the broader societal benefits of vaccination: A path toward sustainable vaccine advocacy in India. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531293 PMCID: PMC9748304 DOI: 10.1016/j.ssmqr.2022.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 06/17/2023]
Abstract
Over the last decade growing public health evidence suggests that, in addition to health-related benefits, there are also social and economic benefits of vaccination. Research to understand how caregivers in low-and-middle-income countries perceive these social and economic benefits, or if these benefits factor into their vaccination decisions for their children, has been limited. Leveraging qualitative strategies to gain more nuanced insights into caregiver perceptions of vaccination benefits has also been significantly underexplored. We conducted in-depth interviews with 13 caregivers of children, at which point we reached saturation, in Mewat District, Haryana, an area in India with low vaccination coverage. Interview results suggest that caregivers of children associate positive health outcomes with vaccination programs, and some additional social and economic benefits beyond improved health outcomes. Caregivers also shared how local advocacy and gaps in vaccination programs can affect their perceptions of vaccination benefits. Qualitatively exploring the perceived benefits provides a unique understanding of the value that caregivers assign to vaccination and complements existing knowledge on factors that dissuade caregivers from vaccination. These insights will allow researchers to better identify and design context-specific advocacy strategies to strengthen vaccination programs in communities with low vaccine uptake and acceptance.
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Affiliation(s)
- Baldeep K. Dhaliwal
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Ananya Rattani
- Bal Umang Drishya Sanstha, E-10, Green Park Main, New Delhi, India
| | | | - David E. Bloom
- Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA
| | - Anita Shet
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Rajeev Seth
- Bal Umang Drishya Sanstha, E-10, Green Park Main, New Delhi, India
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Quaife M, Medley GF, Jit M, Drake T, Asaria M, van Baal P, Baltussen R, Bollinger L, Bozzani F, Brady O, Broekhuizen H, Chalkidou K, Chi YL, Dowdy DW, Griffin S, Haghparast-Bidgoli H, Hallett T, Hauck K, Hollingsworth TD, McQuaid CF, Menzies NA, Merritt MW, Mirelman A, Morton A, Ruiz FJ, Siapka M, Skordis J, Tediosi F, Walker P, White RG, Winskill P, Vassall A, Gomez GB. Considering equity in priority setting using transmission models: Recommendations and data needs. Epidemics 2022; 41:100648. [PMID: 36343495 PMCID: PMC9623400 DOI: 10.1016/j.epidem.2022.100648] [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: 06/17/2021] [Revised: 09/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Disease transmission models are used in impact assessment and economic evaluations of infectious disease prevention and treatment strategies, prominently so in the COVID-19 response. These models rarely consider dimensions of equity relating to the differential health burden between individuals and groups. We describe concepts and approaches which are useful when considering equity in the priority setting process, and outline the technical choices concerning model structure, outputs, and data requirements needed to use transmission models in analyses of health equity. METHODS We reviewed the literature on equity concepts and approaches to their application in economic evaluation and undertook a technical consultation on how equity can be incorporated in priority setting for infectious disease control. The technical consultation brought together health economists with an interest in equity-informative economic evaluation, ethicists specialising in public health, mathematical modellers from various disease backgrounds, and representatives of global health funding and technical assistance organisations, to formulate key areas of consensus and recommendations. RESULTS We provide a series of recommendations for applying the Reference Case for Economic Evaluation in Global Health to infectious disease interventions, comprising guidance on 1) the specification of equity concepts; 2) choice of evaluation framework; 3) model structure; and 4) data needs. We present available conceptual and analytical choices, for example how correlation between different equity- and disease-relevant strata should be considered dependent on available data, and outline how assumptions and data limitations can be reported transparently by noting key factors for consideration. CONCLUSIONS Current developments in economic evaluations in global health provide a wide range of methodologies to incorporate equity into economic evaluations. Those employing infectious disease models need to use these frameworks more in priority setting to accurately represent health inequities. We provide guidance on the technical approaches to support this goal and ultimately, to achieve more equitable health policies.
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Affiliation(s)
- M. Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - GF Medley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - M. Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - T. Drake
- Center for Global Development in Europe (CGD Europe), UK
| | - M. Asaria
- LSE Health, London School of Economics, UK
| | - P. van Baal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
| | - R. Baltussen
- Nijmegen International Center for Health Systems Research and Education, Radboudmc, the Netherlands
| | | | - F. Bozzani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - O. Brady
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - H. Broekhuizen
- Centre for Space, Place, and Society, Wageningen University and Research, Netherlands
| | - K. Chalkidou
- International Decision Support Initiative, Imperial College London, UK
| | - Y.-L. Chi
- International Decision Support Initiative, Imperial College London, UK
| | - DW Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - S. Griffin
- Centre for Health Economics, University of York, UK
| | - H. Haghparast-Bidgoli
- Institute for Global Health, Centre for Global Health Economics, University College London, UK
| | - T. Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - K. Hauck
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - TD Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, UK
| | - CF McQuaid
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - NA Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, USA
| | - MW Merritt
- Johns Hopkins Berman Institute of Bioethics and Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - A. Mirelman
- Centre for Health Economics, University of York, UK
| | - A. Morton
- Department of Management Science, University of Strathclyde, UK
| | - FJ Ruiz
- International Decision Support Initiative, Imperial College London, UK
| | - M. Siapka
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK,Impact Elipsis, Greece
| | - J. Skordis
- Institute for Global Health, Centre for Global Health Economics, University College London, UK
| | - F. Tediosi
- Swiss Tropical and Public Health Institute and Universität Basel, Switzerland
| | - P. Walker
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - RG White
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - P. Winskill
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - A. Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK,Correspondence to: London School of Hygiene and Tropical Medicine, 15 – 17 Tavistock Place, London WC1H 9SH, UK
| | - GB Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
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Choudhary TS, Mazumder S, Haaland OA, Taneja S, Bahl R, Martines J, Bhan MK, Norheim OF, Sommerfelt H, Bhandari N, Johansson KA. Effect of kangaroo mother care initiated in community settings on financial risk protection of low-income households: a randomised controlled trial in Haryana, India. BMJ Glob Health 2022; 7:bmjgh-2022-010000. [PMID: 36379593 PMCID: PMC9668036 DOI: 10.1136/bmjgh-2022-010000] [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: 06/28/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Many families in low-income and middle-income countries have high out-of-pocket expenditures (OOPE) for healthcare, and some face impoverishment. We aimed to assess the effect of Kangaroo Mother Care initiated in community setting (ciKMC) on financial risk protection estimated by healthcare OOPE, catastrophic healthcare expenditure (CHE) and impoverishment due to healthcare seeking for low birthweight infants, using a randomised controlled trial design. METHODS We included 4475 low birthweight infants randomised to a ciKMC (2491 infants) and a control (1984 infants) arm, in a large trial conducted between 2017 and 2018 in Haryana, India. We used generalised linear models of the Gaussian family with an identity link to estimate the mean difference in healthcare OOPE, and Cox regression to estimate the HRs for CHE and impoverishment, between the trial arms. RESULTS Overall, in the 8-week observation period, the mean healthcare OOPE per infant was lower (US$20.0) in the ciKMC arm compared with the control arm (US$25.6) that is, difference of -US$5.5, 95% CI -US$11.4 to US$0.3, p=0.06). Among infants who sought care it was US$8.5 (95% CI -US$17.0 to -US$0.03, p=0.03) lower in the ciKMC arm compared with the control arm. The HR for impoverishment due to healthcare seeking was 0.56 (95% CI 0.36 to 0.89, p=0.01) and it was 0.91 (95% CI 0.74 to 1.12, p=0.37) for CHE. CONCLUSION ciKMC can substantially reduce the cost of care seeking and the risk of impoverishment for households. Our findings show that supporting mothers to provide KMC to low birthweight infants at home, in addition to reducing early infant mortality, may provide financial risk protection. TRIAL REGISTRATION NUMBER CTRI/2017/10/010114.
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Affiliation(s)
- Tarun Shankar Choudhary
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Oystein A Haaland
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Jose Martines
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Ole Frithjof Norheim
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Halvor Sommerfelt
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Cluster for Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Kjell Arne Johansson
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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8
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Nurchis MC, Lontano A, Pascucci D, Sapienza M, Marziali E, Castrini F, Messina R, Regazzi L, Causio FA, Di Pilla A, Vetrugno G, Damiani G, Laurenti P. COVID-19 Vaccination Campaign among the Health Workers of Fondazione Policlinico Universitario Agostino Gemelli IRCCS: A Cost–Benefit Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137848. [PMID: 35805506 PMCID: PMC9265476 DOI: 10.3390/ijerph19137848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022]
Abstract
Vaccinations generate health, economic and social benefits in both vaccinated and unvaccinated populations. The aim of this study was to conduct a cost–benefit analysis to estimate the costs and benefits associated with the COVID-19 vaccination campaign for health workers in Fondazione Policlinico Universitario Agostino Gemelli IRCCS (FPG). The analysis included 5152 healthcare workers who voluntarily received the Pfizer–BioNTech COVID-19 vaccine, divided into physicians, nurses and other health workers. Data about vaccine cost, administration and materials were derived from administrative databases of the FPG from 28 December 2020 to 31 March 2021. The costs associated with the COVID-19 vaccination campaign amounted to EUR 2,221,768, while the benefits equaled EUR 10,345,847. The benefit-to-cost ratio resulted in EUR 4.66, while the societal return on investment showed a ratio of EUR 3.66. The COVID-19 vaccination campaign for health workers in FPG has high social returns and it strengthens the need to inform and update decision-making about the economic and social benefits associated with a vaccination campaign. Health economic evaluations on vaccines should always be considered by decision-makers when considering the inclusion of a new vaccine into the national program.
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Affiliation(s)
- Mario Cesare Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.C.N.); (G.V.); (G.D.); (P.L.)
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
| | - Alberto Lontano
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
- Correspondence:
| | - Domenico Pascucci
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
| | - Martina Sapienza
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
| | - Eleonora Marziali
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
| | - Francesco Castrini
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
| | - Rosaria Messina
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
| | - Luca Regazzi
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
| | - Francesco Andrea Causio
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
| | - Andrea Di Pilla
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
| | - Giuseppe Vetrugno
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.C.N.); (G.V.); (G.D.); (P.L.)
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Gianfranco Damiani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.C.N.); (G.V.); (G.D.); (P.L.)
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
| | - Patrizia Laurenti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.C.N.); (G.V.); (G.D.); (P.L.)
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, 00168 Rome, Italy; (D.P.); (M.S.); (E.M.); (F.C.); (R.M.); (L.R.); (F.A.C.); (A.D.P.)
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9
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Kretzschmar ME, Ashby B, Fearon E, Overton CE, Panovska-Griffiths J, Pellis L, Quaife M, Rozhnova G, Scarabel F, Stage HB, Swallow B, Thompson RN, Tildesley MJ, Villela D. Challenges for modelling interventions for future pandemics. Epidemics 2022; 38:100546. [PMID: 35183834 PMCID: PMC8830929 DOI: 10.1016/j.epidem.2022.100546] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/16/2022] Open
Abstract
Mathematical modelling and statistical inference provide a framework to evaluate different non-pharmaceutical and pharmaceutical interventions for the control of epidemics that has been widely used during the COVID-19 pandemic. In this paper, lessons learned from this and previous epidemics are used to highlight the challenges for future pandemic control. We consider the availability and use of data, as well as the need for correct parameterisation and calibration for different model frameworks. We discuss challenges that arise in describing and distinguishing between different interventions, within different modelling structures, and allowing both within and between host dynamics. We also highlight challenges in modelling the health economic and political aspects of interventions. Given the diversity of these challenges, a broad variety of interdisciplinary expertise is needed to address them, combining mathematical knowledge with biological and social insights, and including health economics and communication skills. Addressing these challenges for the future requires strong cross-disciplinary collaboration together with close communication between scientists and policy makers.
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Affiliation(s)
- Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Ben Ashby
- Department of Mathematical Sciences, University of Bath, Bath BA2 7AY, UK
| | - Elizabeth Fearon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK; Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, UK
| | - Christopher E Overton
- Department of Mathematics, University of Manchester, UK; Joint UNIversities Pandemic and Epidemiological Research, UK; Clinical Data Science Unit, Manchester University NHS Foundation Trust, UK
| | - Jasmina Panovska-Griffiths
- The Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK; The Queen's College, University of Oxford, Oxford, UK
| | - Lorenzo Pellis
- Department of Mathematics, University of Manchester, UK; Joint UNIversities Pandemic and Epidemiological Research, UK; The Alan Turing Institute, London, UK
| | - Matthew Quaife
- TB Modelling Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
| | - Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; BioISI-Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Francesca Scarabel
- Department of Mathematics, University of Manchester, UK; Joint UNIversities Pandemic and Epidemiological Research, UK; CDLab - Computational Dynamics Laboratory, Department of Mathematics, Computer Science and Physics, University of Udine, Italy
| | - Helena B Stage
- Department of Mathematics, University of Manchester, UK; Joint UNIversities Pandemic and Epidemiological Research, UK; University of Potsdam, Germany; Humboldt University of Berlin, Germany
| | - Ben Swallow
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK; Scottish Covid-19 Response Consortium, UK
| | - Robin N Thompson
- Joint UNIversities Pandemic and Epidemiological Research, UK; Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry CV4 7AL, UK
| | - Michael J Tildesley
- Joint UNIversities Pandemic and Epidemiological Research, UK; Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry CV4 7AL, UK
| | - Daniel Villela
- Program of Scientific Computing, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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10
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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.
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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
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11
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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.
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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
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12
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Lamu AN, Norheim OF, Gregersen FA, Barra M. Cycle-network expansion plan in Oslo: Modeling cost-effectiveness analysis and health equity impact. HEALTH ECONOMICS 2021; 30:3220-3235. [PMID: 34611965 DOI: 10.1002/hec.4435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
Physical inactivity is the leading cause of non-communicable diseases, and further research on the cost-effectiveness of interventions that target inactivity is warranted. Socioeconomic status is vital in this process. We aim to evaluate the cost-effectiveness of a cycle-network expansion plan in Oslo compared to the status quo by income quintiles. We applied a Markov model using a public payer perspective. Health outcomes were measured by quality-adjusted life years (QALYs) gained from the prevention of coronary heart disease, stroke, type 2 diabetes, and cancer. We measured equity impact by the concentration index and social welfare using the achievement index. We conducted sensitivity analyses. The intervention was generally more costly and more effective than the status quo. Incremental cost per QALY falls with income quintile, ranging from $10,098 in the richest quintile to $23,053 per QALY gained in the poorest quintile. The base-case intervention increased health inequality. However, a scenario targeting low-income quintiles reduced inequality and increased social welfare. In conclusion, the cycle-network expansion is likely to be cost-effective, but with equity concerns. If decision makers care about health inequalities, the disadvantaged groups could be targeted to produce more equitable and socially desirable outcomes instead of a uniform intervention across income quintiles.
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Affiliation(s)
- Admassu N Lamu
- Department of Global Public Health and Primary Care, Centre for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, Centre for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
| | - Fredrik A Gregersen
- Norwegian Centre for Transport Research, The Institute of Transport Economics, Oslo, Norway
| | - Mathias Barra
- Department of Global Public Health and Primary Care, Centre for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
- The Health Service Research Unit (HØKH), Akershus Universitetssykehus HF, Lørenskog, Norway
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13
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Obi-Jeff C, Garcia C, Onuoha O, Adewumi F, David W, Bamiduro T, Aliyu AB, Labrique A, Wonodi C. Designing an SMS reminder intervention to improve vaccination uptake in Northern Nigeria: a qualitative study. BMC Health Serv Res 2021; 21:844. [PMID: 34416906 PMCID: PMC8379866 DOI: 10.1186/s12913-021-06728-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Penta3 coverage in Nigeria was low at 33 % in 2017. The most reported reason for non-vaccination was lack of knowledge about the immunization place, time, and need. To address knowledge gaps and improve vaccination uptake, we designed an Immunization Reminder and Information SMS System (IRISS) to educate and remind parents/caregivers about immunization using SMS. A formative study was conducted to understand the contextual and behavioural factors that would inform the IRISS intervention design and implementation. METHODS We conducted the study in four Local Government Areas (LGAs) of Kebbi State Nigeria in October 2018, amongst a diverse selection of participants. Data on social norms about vaccinations, barriers to immunization uptake, mobile phone use, SMS message testing, and willingness to accept SMS reminders were collected from focus group discussions (N = 11), in-depth interviews (N = 12), and key informant interviews (N = 13). In addition, we assessed 33 messages covering schedule reminders, normative, motivational, educational, and informative contents for clarity, comprehensibility, relevance, cultural appropriateness, and ability to motivate action among community members from Argungu and Fakai LGAs. All interviews were analyzed using a thematic analysis approach. RESULTS We interviewed 135 people, and 90 % were community members. While we found positive perceptions about immunizations among those interviewed, pockets of misconceptions existed among community members. Lack of awareness on the importance of vaccination was a consistent reason for under-vaccination across the LGAs. In addition, most community members do not own phones, could not read SMS messages, and were unaware of how to check/open text messages received. Despite concerns about low literacy levels and phone ownership, community members still saw a role in SMS reminders when phone owners receive messages. For instance, community leaders can disseminate said messages to community members through existing channels such as town announcers and religious gatherings. Therefore, the SMS becomes a source of information, with phone owners acting as a conduit to community dissemination mechanisms. We generally found the tested messages to be relevant, motivating, and culturally acceptable. CONCLUSIONS SMS reminders have the potential to bridge the information gap in community awareness for vaccination, which can translate to improved immunization uptake. In rural communities with low literacy levels and phone ownership, immunization information can be disseminated when existing community leadership structures are engaged.
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Affiliation(s)
- Chisom Obi-Jeff
- Department of Research, Direct Consulting and Logistics Limited, Abuja, Federal Capital Territory, Nigeria.
| | - Cristina Garcia
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, Baltimore, USA
| | - Obinna Onuoha
- Department of Research, Direct Consulting and Logistics Limited, Abuja, Federal Capital Territory, Nigeria
| | - Funmi Adewumi
- Department of Research, Direct Consulting and Logistics Limited, Abuja, Federal Capital Territory, Nigeria
| | - Winnie David
- Department of Research, Direct Consulting and Logistics Limited, Abuja, Federal Capital Territory, Nigeria
| | - Tobi Bamiduro
- Department of Research, Direct Consulting and Logistics Limited, Abuja, Federal Capital Territory, Nigeria
| | - Abdulrasheed Bello Aliyu
- Department of Primary Health Care System Development, Kebbi State Primary Health Care Development Agency, Birnin Kebbi, Kebbi State, Nigeria
| | - Alain Labrique
- Department of International Health and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, Baltimore, USA
| | - Chizoba Wonodi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, Baltimore, USA
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14
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Batura N, Saweri OP, Vallely A, Pomat W, Homer C, Guy R, Luchters S, Mola G, Vallely LM, Morgan C, Kariwiga G, Wand H, Rogerson S, Tabrizi SN, Whiley DM, Low N, Peeling RW, Siba PM, Riddell M, Laman M, Bolnga J, Robinson LJ, Morewaya J, Badman S, Kelly-Hanku A, Toliman PJ, Peter W, Peach E, Garland S, Kaldor J, Wiseman V. Point-of-care testing and treatment of sexually transmitted and genital infections during pregnancy in Papua New Guinea (WANTAIM trial): protocol for an economic evaluation alongside a cluster-randomised trial. BMJ Open 2021; 11:e046308. [PMID: 34385236 PMCID: PMC8362726 DOI: 10.1136/bmjopen-2020-046308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Left untreated, sexually transmitted and genital infections (henceforth STIs) in pregnancy can lead to serious adverse outcomes for mother and child. Papua New Guinea (PNG) has among the highest prevalence of curable STIs including syphilis, chlamydia, gonorrhoea, trichomoniasis and bacterial vaginosis, and high neonatal mortality rates. Diagnosis and treatment of these STIs in PNG rely on syndromic management. Advances in STI diagnostics through point-of-care (PoC) testing using GeneXpert technology hold promise for resource-constrained countries such as PNG. This paper describes the planned economic evaluation of a cluster-randomised cross-over trial comparing antenatal PoC testing and immediate treatment of curable STIs with standard antenatal care in two provinces in PNG. METHODS AND ANALYSIS Cost-effectiveness of the PoC intervention compared with standard antenatal care will be assessed prospectively over the trial period (2017-2021) from societal and provider perspectives. Incremental cost-effectiveness ratios will be calculated for the primary health outcome, a composite measure of the proportion of either preterm birth and/or low birth weight; for life years saved; for disability-adjusted life years averted; and for non-health benefits (financial risk protection and improved health equity). Scenario analyses will be conducted to identify scale-up options, and budget impact analysis will be undertaken to understand short-term financial impacts of intervention adoption on the national budget. Deterministic and probabilistic sensitivity analysis will be conducted to account for uncertainty in key model inputs. ETHICS AND DISSEMINATION This study has ethical approval from the Institutional Review Board of the PNG Institute of Medical Research; the Medical Research Advisory Committee of the PNG National Department of Health; the Human Research Ethics Committee of the University of New South Wales; and the Research Ethics Committee of the London School of Hygiene and Tropical Medicine. Findings will be disseminated through national stakeholder meetings, conferences, peer-reviewed publications and policy briefs. TRIAL REGISTRATION NUMBER ISRCTN37134032.
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Affiliation(s)
- Neha Batura
- Institute for Global Health, University College London, London, UK
| | - Olga Pm Saweri
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew Vallely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - William Pomat
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Caroline Homer
- The Burnet Institute, Melbourne, Victoria, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Rebecca Guy
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Stanley Luchters
- The Burnet Institute, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Ghent University, Ghent, Belgium
- Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya
- Department of Epidemiology and Preventive Medicine, Monash University, Monash, Victoria, Australia
| | - Glen Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Lisa M Vallely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | | | - Grace Kariwiga
- Milne Bay Provincial Health Authority, Alotau, Papua New Guinea
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Rogerson
- Department of Medicine, The Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
| | | | - David M Whiley
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter M Siba
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Michaela Riddell
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - John Bolnga
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Leanne J Robinson
- The Burnet Institute, Melbourne, Victoria, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Jacob Morewaya
- Milne Bay Provincial Health Authority, Alotau, Papua New Guinea
| | - Steven Badman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Angela Kelly-Hanku
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Pamela J Toliman
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Wilfred Peter
- Madang Provincial Health Authority, Madang, Papua New Guinea
| | | | - Suzanne Garland
- Microbiology and Infectious Diseases Department, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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15
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Portnoy A, Sweet S, Desalegn D, Memirie ST, Kim JJ, Verguet S. Health gains and financial protection from human papillomavirus vaccination in Ethiopia: findings from a modelling study. Health Policy Plan 2021; 36:891-899. [PMID: 33942850 PMCID: PMC8227995 DOI: 10.1093/heapol/czab052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 12/24/2022] Open
Abstract
High out-of-pocket (OOP) medical expenses for cervical cancer (CC) can lead to catastrophic health expenditures (CHEs) and medical impoverishment in many low-resource settings. There are 32 million women at risk for CC in Ethiopia, where CC screening is extremely limited. An evaluation of the population health and financial risk protection benefits, and their distributional consequences across socioeconomic groups, from human papillomavirus (HPV) vaccination will be critical to support CC prevention efforts in this setting. We used a static cohort model that captures the main features of HPV vaccines and population demographics to project health and economic outcomes associated with routine HPV vaccination in Ethiopia. Health outcomes included the number of CC cases, and costs included vaccination and operational costs in 2015 US dollars over the years 2019–2118 and CC treatment costs over the lifetimes of cohorts eligible for vaccination in Ethiopia. We estimated the household OOP medical expenditures averted (assuming 68% of direct medical expenditures were financed OOP) and cases of CHE averted. A case of CHE was defined as 40% of household consumption expenditures, and the cases of CHE averted depended on wealth quintile, disease incidence, healthcare use and OOP payments. Our analysis shows that, assuming 100% vaccine efficacy against HPV-16/18 and 50% vaccination coverage, routine HPV vaccination could avert up to 970 000 cases of CC between 2019 and 2118, which translates to ∼932 000 lives saved. Additionally, routine HPV vaccination could avert 33 900 cases of CHE. Approximately one-third of health benefits would accrue to the poorest wealth quintile, whereas 50% of financial risk protection benefits would accrue to this quintile. HPV vaccination can reduce disparities in CC incidence, mortality and household health expenditures. This understanding and our findings can help policymakers in decisions regarding targeted CC control efforts and investment in a routine HPV vaccination programme following an initial catch-up programme.
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Affiliation(s)
- Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA
| | - Steven Sweet
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA.,Vitalant Research Institute, 270 Masonic Avenue, San Francisco, CA 94118, USA
| | - Dawit Desalegn
- Department of Gynecology and Obstetrics, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Tessema Memirie
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA
| | - Stéphane Verguet
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
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16
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Cookson R, Robson M, Skarda I, Doran T. Equity-informative methods of health services research. J Health Organ Manag 2021; ahead-of-print:665-681. [PMID: 34189877 DOI: 10.1108/jhom-07-2020-0275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE We review quantitative methods for analysing the equity impacts of health care and public health interventions: who benefits most and who bears the largest burdens (opportunity costs)? Mainstream health services research focuses on effectiveness and efficiency but decision makers also need information about equity. DESIGN/METHODOLOGY/APPROACH We review equity-informative methods of quantitative data analysis in three core areas of health services research: effectiveness analysis, cost-effectiveness analysis and performance measurement. An appendix includes further readings and resources. FINDINGS Researchers seeking to analyse health equity impacts now have a practical and flexible set of methods at their disposal which builds on the standard health services research toolkit. Some of the more advanced methods require specialised skills, but basic equity-informative methods can be used by any health services researcher with appropriate skills in the three core areas. ORIGINALITY/VALUE We hope that this review will raise awareness of equity-informative methods of health services research and facilitate their entry into the mainstream so that health policymakers are routinely presented with information about who gains and who loses from their decisions.
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Affiliation(s)
| | - Matthew Robson
- Department of Health Sciences, University of York, York, UK
| | - Ieva Skarda
- Centre for Health Economics, University of York, York, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
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Saweri OPM, Batura N, Al Adawiyah R, Causer LM, Pomat WS, Vallely AJ, Wiseman V. Economic evaluation of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low- and middle-income countries: A systematic review. PLoS One 2021; 16:e0253135. [PMID: 34138932 PMCID: PMC8211269 DOI: 10.1371/journal.pone.0253135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sexually transmitted and genital infections in pregnancy are associated with adverse pregnancy and birth outcomes. Point-of-care tests for these infections facilitate testing and treatment in a single antenatal clinic visit and may reduce the risk of adverse outcomes. Successful implementation and scale-up depends on understanding comparative effectiveness of such programmes and their comparative costs and cost effectiveness. This systematic review synthesises and appraises evidence from economic evaluations of point-of-care testing and treatment for sexually transmitted and genital infections among pregnant women in low- and middle-income countries. METHODS Medline, Embase and Web of Science databases were comprehensively searched using pre-determined criteria. Additional literature was identified by searching Google Scholar and the bibliographies of all included studies. Economic evaluations were eligible if they were set in low- and middle-income countries and assessed antenatal point-of-care testing and treatment for syphilis, chlamydia, gonorrhoea, trichomoniasis, and/or bacterial vaginosis. Studies were analysed using narrative synthesis. Methodological and reporting standards were assessed using two published checklists. RESULTS Sixteen economic evaluations were included in this review; ten based in Africa, three in Latin and South America and three were cross-continent comparisons. Fifteen studies assessed point-of-care testing and treatment for syphilis, while one evaluated chlamydia. Key drivers of cost and cost-effectiveness included disease prevalence; test, treatment, and staff costs; test sensitivity and specificity; and screening and treatment coverage. All studies met 75% or more of the criteria of the Drummond Checklist and 60% of the Consolidated Health Economics Evaluation Reporting Standards. CONCLUSIONS Generally, point-of-care testing and treatment was cost-effective compared to no screening, syndromic management, and laboratory-based testing. Future economic evaluations should consider other common infections, and their lifetime impact on mothers and babies. Complementary affordability and equity analyses would strengthen the case for greater investment in antenatal point-of-care testing and treatment for sexually transmitted and genital infections.
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Affiliation(s)
- Olga P. M. Saweri
- The Kirby Institute, University of New South Wales, Sydney, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- * E-mail:
| | - Neha Batura
- University College London, London, United Kingdom
| | | | - Louise M. Causer
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - William S. Pomat
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew J. Vallely
- The Kirby Institute, University of New South Wales, Sydney, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, Australia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Cookson R, Griffin S, Norheim OF, Culyer AJ, Chalkidou K. Distributional Cost-Effectiveness Analysis Comes of Age. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:118-120. [PMID: 33431145 PMCID: PMC7813213 DOI: 10.1016/j.jval.2020.10.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/06/2020] [Indexed: 05/23/2023]
Affiliation(s)
- Richard Cookson
- Centre for Health Economics, University of York, York, England, UK.
| | - Susan Griffin
- Centre for Health Economics, University of York, York, England, UK
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Anthony J Culyer
- Centre for Health Economics, University of York, York, England, UK
| | - Kalipso Chalkidou
- Faculty of Medicine, School of Public Health, Imperial College London, London, England, UK
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Karsu Ö, Morton A. Trading off health and financial protection benefits with multiobjective optimization. HEALTH ECONOMICS 2021; 30:55-69. [PMID: 33073441 DOI: 10.1002/hec.4176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/18/2020] [Accepted: 06/25/2020] [Indexed: 05/26/2023]
Abstract
Countries which are introducing a system of Universal health coverage have to make a number of key tradeoffs, of which one is the tradeoff between the level of coverage and the degree to which patients are exposed to potentially catastrophic financial risk. In this study, we first present a way in which decision makers might be supported to focus on in a particular part of the tradeoff curve and ultimately choose an efficient solution. We then introduce some multiobjective optimization models for generating the tradeoff curves given data about potential treatment numbers, costs, and benefits. Using a dataset from Malawi, we demonstrate the approach and suggest a core index metric to make specific observations on the individual treatments. Moreover, as there has been some debate about the best way to measure financial exposure, we also investigate the extent to sensitivity of our results to the precise technical choice of financial exposure metric. Specifically, we consider two metrics, which are the total number of cases protected from catastrophic expenditure and a convex penalty function that penalizes out-of-pocket expenditures in an increasingly growing way, respectively.
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Affiliation(s)
- Özlem Karsu
- Department of Industrial Engineering, Bilkent University, Ankara, Turkey
| | - Alec Morton
- Management Science Department, University of Strathclyde Business School, Glasgow, UK
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Rodrigues CMC, Plotkin SA. Impact of Vaccines; Health, Economic and Social Perspectives. Front Microbiol 2020; 11:1526. [PMID: 32760367 PMCID: PMC7371956 DOI: 10.3389/fmicb.2020.01526] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022] Open
Abstract
In the 20th century, the development, licensing and implementation of vaccines as part of large, systematic immunization programs started to address health inequities that existed globally. However, at the time of writing, access to vaccines that prevent life-threatening infectious diseases remains unequal to all infants, children and adults in the world. This is a problem that many individuals and agencies are working hard to address globally. As clinicians and biomedical scientists we often focus on the health benefits that vaccines provide, in the prevention of ill-health and death from infectious pathogens. Here we discuss the health, economic and social benefits of vaccines that have been identified and studied in recent years, impacting all regions and all age groups. After learning of the emergence of SARS-CoV-2 virus in December 2019, and its potential for global dissemination to cause COVID-19 disease was realized, there was an urgent need to develop vaccines at an unprecedented rate and scale. As we appreciate and quantify the health, economic and social benefits of vaccines and immunization programs to individuals and society, we should endeavor to communicate this to the public and policy makers, for the benefit of endemic, epidemic, and pandemic diseases.
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Affiliation(s)
- Charlene M. C. Rodrigues
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Department of Paediatric Infectious Diseases, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stanley A. Plotkin
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, United States
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Arsenault C, Harper S, Nandi A. Effect of vaccination on children’s learning achievements: findings from the India Human Development Survey. J Epidemiol Community Health 2020; 74:778-784. [DOI: 10.1136/jech-2019-213483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/03/2020] [Accepted: 05/20/2020] [Indexed: 11/04/2022]
Abstract
BackgroundBeyond the prevention of illness and death, vaccination may provide additional benefits such as improved educational outcomes. However, there is currently little evidence on this question. Our objective was to estimate the effect of childhood vaccination on learning achievements among primary school children in India.MethodsWe used cohort data from the India Human Development Survey. Vaccination status and confounders were measured among children who were at least 12 months old at baseline in 2004–2005. In 2011–2012, the same children completed basic reading, writing and math tests. We estimated the effect of full vaccination during childhood on learning achievements using inverse probability of treatment-weighted logistic regression models and results reported on the risk difference scale. The propensity score included 33 potential community-, household-, mother- and child-level confounders as well as state fixed effects.ResultsAmong the 4877 children included in our analysis, 54% were fully vaccinated at baseline, and 54% could read by the age of 8–11 years. The estimated effect of full vaccination on learning achievements ranged from 4 to 6 percentage points, representing relative increases ranging from 6% to 12%. Bias analysis suggested that our observed effects could be explained by unmeasured confounding, but only in the case of strong associations with the treatment and outcome.ConclusionThese results support the hypothesis that vaccination has lasting effects on children’s learning achievements. Further work is needed to confirm findings and elucidate the potential mechanisms linking vaccines to educational outcomes.
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Garrison LP, Zamora B, Li M, Towse A. Augmenting Cost-Effectiveness Analysis for Uncertainty: The Implications for Value Assessment-Rationale and Empirical Support. J Manag Care Spec Pharm 2020; 26:400-406. [PMID: 32223599 PMCID: PMC10391119 DOI: 10.18553/jmcp.2020.26.4.400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
DISCLOSURES This study received unrestricted funding from the Pharmaceutical Research Manufacturers of America. The authors also do consulting, personally or through their employment, with numerous pharmaceutical manufacturers, payers, and other stakeholders with a general interest in this subject matter.
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Affiliation(s)
- Louis P. Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
| | | | - Meng Li
- Leonard D. Schaeffer Center For Health Policy & Economics, University of Southern California, Los Angeles
| | - Adrian Towse
- Office of Health Economics, London, United Kingdom
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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.
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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
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Love-Koh J, Griffin S, Kataika E, Revill P, Sibandze S, Walker S. Methods to promote equity in health resource allocation in low- and middle-income countries: an overview. Global Health 2020; 16:6. [PMID: 31931823 PMCID: PMC6958737 DOI: 10.1186/s12992-019-0537-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/20/2019] [Indexed: 11/02/2022] Open
Abstract
Unfair differences in healthcare access, utilisation, quality or health outcomes exist between and within countries around the world. Improving health equity is a stated objective for many governments and international organizations. We provide an overview of the major tools that have been developed to measure, evaluate and promote health equity, along with the data required to operationalise them.Methods are organised into four key policy questions facing decision-makers: (i) what is the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity.Benefit incidence analysis can be used to estimate the distribution of current public health sector expenditure, with geographical resource allocation formulae and health system reform being the main government policy levers for improving equity. Techniques from the economic evaluation literature, such as extended and distributional cost-effectiveness analysis can be used to identify 'best buy' interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity.Methods from the economics literature can provide policymakers with a toolkit for addressing multiple aspects of health equity, from outcomes to financial protection, and can be adapted to accommodate data commonly available in low- and middle-income settings.
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Affiliation(s)
- James Love-Koh
- Centre for Health Economics, University of York, York, England.
| | - Susan Griffin
- Centre for Health Economics, University of York, York, England
| | - Edward Kataika
- East, Central and Southern Africa Health Community, Arusha, Tanzania
| | - Paul Revill
- Centre for Health Economics, University of York, York, England
| | - Sibusiso Sibandze
- East, Central and Southern Africa Health Community, Arusha, Tanzania
| | - Simon Walker
- Centre for Health Economics, University of York, York, England
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Malik A, Haldar P, Ray A, Shet A, Kapuria B, Bhadana S, Santosham M, Ghosh RS, Steinglass R, Kumar R. Introducing rotavirus vaccine in the Universal Immunization Programme in India: From evidence to policy to implementation. Vaccine 2019; 37:5817-5824. [PMID: 31474519 PMCID: PMC6996154 DOI: 10.1016/j.vaccine.2019.07.104] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/26/2022]
Abstract
India became one of the first countries in Asia to introduce rotavirus vaccine. Rotavirus vaccine is being expanded to the entire country in a phase wised manner. The new vaccine introduction strengthened the programme rather than burdening it.
Background In 2016, India became one of the first countries in Asia to introduce an indigenously manufactured rotavirus vaccine. However, any new vaccine introduction needs to be meticulously planned to allow for strengthening of the existing immunization systems instead of burdening them. Methods The process of rotavirus vaccine introduction in India started with the establishment of National Rotavirus Surveillance Network in 2005 which generated relevant evidence to inform policy level decisions to introduce the vaccine. The preparatory activities started with assessment of health systems and closing any gaps. This was followed by development of vaccine specific training packages and cascade training for programme managers and health workers. The introduction was complemented with strong communications systems and media involvement to allow for good acceptability of the vaccine on the ground. Each step of introduction was led by the government and technically supported by development partners. Results India introduced rotavirus vaccine in a phased wise manner. In the first two phases the vaccine has been introduced in nine states of the country accounting for nearly 35% of the annual birth cohort of the country. From March 2016 to November 2017, approximately 13,260,000 rotavirus vaccine doses were administered in the country. The vaccine was well accepted by both the health workers and parents/caregivers. Conclusion Rotavirus vaccine introduction in India is an excellent example of how government stewardship with well-defined roles for development partners can allow a new vaccine introduction to be used as a system strengthening activity.
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Affiliation(s)
- Akash Malik
- United Nations Development Programme, India.
| | - Pradeep Haldar
- Ministry of Health and Family Welfare, Government of India, India
| | | | - Anita Shet
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | | | - Sheenu Bhadana
- Immunization Technical Support Unit, Ministry of Health and Family Welfare, Government of India, India
| | - Mathuram Santosham
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
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Woyessa AB, Abebe A, Beyene B, Tefera M, Assefa E, Ketema H, Teshome B, Bekele A, Dugasa Y, Habebe S, Assefa Z, Sufa D, Alemu D, Tilahun H, Biru M, Shume G. Rotavirus-associated acute diarrhea outbreak in West Shewa Zone of Oromia Regional State, Ethiopia, 2017. Pan Afr Med J 2019; 32:202. [PMID: 31312314 PMCID: PMC6620077 DOI: 10.11604/pamj.2019.32.202.18188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/07/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Rotavirus causes severe-diarrheal diseases in infants. An estimation of 138 million rotavirus-associated diarrheal cases and 215,000 deaths occur every year globally. In December 2016, West-Shewa zone in Ethiopia reported unidentified gastrointestinal diarrhea outbreak. We investigated to identify the causative agent of the outbreak to support response operations. Methods Medical records were reviewed, and the daily line list was collected from health facilities. Descriptive data analysis was done by time, person and place. Stool specimens were first tested by antigen capture enzyme immunoassay (EIA) technique and further confirmed by reverse-transcription polymerase chain reaction (RT-PCR) as a gold standard. The product of RT-PCR was genotyped for each gene using G1-G4, G8-G9 and G12 primers for VP7 gene and P(4), P(6), P(8) and P(14) primers for VP4 gene. Results A total of 1,987 diarrheal cases (5.7 per 1000) and five deaths (case-fatality rate 0.25%) were identified and epidemiologically-linked to confirmed rotavirus from December 2016 to February 2017. Among the cases, 1,946 (98%) were < 5 children. Fourteen (74%) of the 19 tested stool specimens were positive for rotavirus by EIA and RT-PCR. Majority of strains detected were G12P(6) (25%) and G-negative P(8) (25%) followed by G9P(8) (19%), G1P(8) (13%) and G3/G2 P(8), G12P(8), and G-negative P(6) (6% each). Conclusion Diarrheal outbreak which occurred in West-Shewa zone of Ethiopia was associated with rotavirus and relatively more affected districts with low vaccination coverage. Routine rotavirus vaccination quality and coverage should be evaluated and the surveillance system needs to be strengthened to detect, prevent and control a similar outbreak.
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Affiliation(s)
- Abyot Bekele Woyessa
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Almaz Abebe
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Berhane Beyene
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mesfin Tefera
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Esete Assefa
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Hiwot Ketema
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Birke Teshome
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ayenachew Bekele
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yohanis Dugasa
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Shambel Habebe
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zewdu Assefa
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Diriba Sufa
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Habtamu Tilahun
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mengistu Biru
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Gemechu Shume
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
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Isaranuwatchai W, Li R, Glassman A, Teerawattananon Y, Culye AJ, Chalkidou K. Disease Control Priorities Third Edition: Time to Put a Theory of Change Into Practice Comment on "Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy". Int J Health Policy Manag 2019; 8:132-135. [PMID: 30980627 PMCID: PMC6462203 DOI: 10.15171/ijhpm.2018.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 11/17/2018] [Indexed: 01/17/2023] Open
Abstract
The Disease Control Priorities program (DCP) has pioneered the use of economic evidence in health. The theory of change (ToC) put forward by Norheim is a further welcome and necessary step towards translating DCP evidence into better priority setting in low- and middle-income countries (LMICs). We also agree that institutionalising evidence for informed priority-setting processes is crucial. Unfortunately, there have been missed opportunities for the DCP program to challenge ill-judged global norms about opportunity costs and too little respect has been shown for the wider set of local circumstances that may enable, or disable, the productive application of the DCP evidence base. We suggest that the best way forward for the global health community is a new platform that integrates the many existing development initiatives and that is driven by countries’ asks.
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, ON, Canada
| | - Ryan Li
- School of Public Health, Imperial College London, London, UK
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Anthony J Culye
- Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, UK.,Center for Global Development, London, UK
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Zegeye EA, Reshad A, Bekele EA, Aurgessa B, Gella Z. The State of Health Technology Assessment in the Ethiopian Health Sector: Learning from Recent Policy Initiatives. Value Health Reg Issues 2018; 16:61-65. [PMID: 30195092 DOI: 10.1016/j.vhri.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 11/25/2022]
Abstract
Health technology assessment (HTA) has previously been implemented only in a fragmented manner in the Ethiopian health sector decision-making cycle, and the sector has been hampered by limited institutional capacity and skilled human resources to inform evidence-based decision making. The country is in the midst of widescale implementation of a community-based health insurance scheme and is preparing for the launch of a social health insurance scheme. The country continues to face a limited financial resource envelope, undergoing an epidemiological transition, and is facing a much greater burden of noncommunicable diseases, for which the essential health benefit package, defined 12 years ago, may no longer be suitable. This has called for an in-depth review of the application of HTA in the context of the current health needs and institutional settings. To meet the increasing need for HTA, the Health Economics and Financing Analysis (HEFA) team was established within the Finance Resource Mobilization Department under the Ministry of Health. The HEFA team is tasked with spearheading the application of evidence-based health care decision making in Ethiopia by organizing available evidence, costing interventions, and defining effectiveness measures of the different health programs and then supporting policymakers at the national and regional levels. Improving and harmonizing the institutional approach to HTA, including staffing the HEFA team with the appropriate mix of expertise, and networking with relevant sector organizations will improve Ethiopia's ability to tackle the current health sector challenges as well as protect fledgling insurance schemes' progress toward universal health coverage.
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Affiliation(s)
- Elias Asfaw Zegeye
- Health Economics and Financing Analysis Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia.
| | | | - Eyersualem Animut Bekele
- Partnership and Coordination Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Belay Aurgessa
- Partnership and Coordination Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Zenebech Gella
- Health Economics and Financing Analysis Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
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Apte A, Roy S, Bavdekar A, Juvekar S, Hirve S. Facilitators and barriers for use of rotavirus vaccine amongst various stakeholders and its implications for Indian context - A systematic review. Hum Vaccin Immunother 2018; 14:2760-2767. [PMID: 29913110 DOI: 10.1080/21645515.2018.1489190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: We performed a systematic review to evaluate factors affecting uptake of rotavirus vaccine amongst physicians, parents and health system. Methods: We identified 15 studies that met the inclusion criteria from 790 screened studies published between Jan 2005 to Jan 2016. Results: Perceived severity of rotavirus disease, efficacy of vaccine and recommendation by health authorities positively influenced uptake of vaccine amongst health care providers. Routine and timely vaccination with routine vaccines and availability of rotavirus vaccine in public health programme facilitated uptake. Family income, parental education and employment status positively influenced the decision to vaccinate by parents. Concerns about safety, high cost, additional workload and logistic problems in acquiring vaccine stocks were perceived as barriers. Conclusion: Improved awareness regarding the rotavirus vaccination amongst public and scientific community and strengthening of public health system for better and timely immunisation coverage are important factors to maximize uptake of rotavirus vaccine in India.
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Affiliation(s)
- Aditi Apte
- a Department of Pediatric Research, KEM Hospital Research Centre , Pune , India
| | - Sudipto Roy
- b Vadu Rural Health Program, KEM Hospital Research Centre , Pune , India
| | - Ashish Bavdekar
- a Department of Pediatric Research, KEM Hospital Research Centre , Pune , India
| | - Sanjay Juvekar
- b Vadu Rural Health Program, KEM Hospital Research Centre , Pune , India
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Chang AY, Riumallo-Herl C, Salomon JA, Resch SC, Brenzel L, Verguet S. Estimating the distribution of morbidity and mortality of childhood diarrhea, measles, and pneumonia by wealth group in low- and middle-income countries. BMC Med 2018; 16:102. [PMID: 29970074 PMCID: PMC6030776 DOI: 10.1186/s12916-018-1074-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 05/14/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Equitable access to vaccines has been suggested as a priority for low- and middle-income countries (LMICs). However, it is unclear whether providing equitable access is enough to ensure health equity. Furthermore, disaggregated data on health outcomes and benefits gained across population subgroups are often unavailable. This paper develops a model to estimate the distribution of childhood disease cases and deaths across socioeconomic groups, and the potential benefits of three vaccine programs in LMICs. METHODS For each country and for three diseases (diarrhea, measles, pneumonia), we estimated the distributions of cases and deaths that would occur across wealth quintiles in the absence of any immunization or treatment programs, using both the prevalence and relative risk of a set of risk and prognostic factors. Building on these baseline estimates, we examined what might be the impact of three vaccines (first dose of measles, pneumococcal conjugate, and rotavirus vaccines), under five scenarios based on different sets of quintile-specific immunization coverage and disease treatment utilization rates. RESULTS Due to higher prevalence of risk factors among the poor, disproportionately more disease cases and deaths would occur among the two lowest wealth quintiles for all three diseases when vaccines or treatment are unavailable. Country-specific context, including how the baseline risks, immunization coverage, and treatment utilization are currently distributed across quintiles, affects how different policies translate into changes in cases and deaths distribution. CONCLUSIONS Our study highlights several factors that would substantially contribute to the unequal distribution of childhood diseases, and finds that merely ensuring equal access to vaccines will not reduce the health outcomes gap across wealth quintiles. Such information can inform policies and planning of programs that aim to improve equitable delivery of healthcare services.
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Affiliation(s)
- Angela Y Chang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Carlos Riumallo-Herl
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Erasmus School of Economics, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - Joshua A Salomon
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen C Resch
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Boujaoude MA, Mirelman AJ, Dalziel K, Carvalho N. Accounting for equity considerations in cost-effectiveness analysis: a systematic review of rotavirus vaccine in low- and middle-income countries. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:18. [PMID: 29796012 PMCID: PMC5960127 DOI: 10.1186/s12962-018-0102-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023] Open
Abstract
Background Cost-effectiveness analysis (CEA) is frequently used as an input for guiding priority setting in health. However, CEA seldom incorporates information about trade-offs between total health gains and equity impacts of interventions. This study investigates to what extent equity considerations have been taken into account in CEA in low- and middle-income countries (LMICs), using rotavirus vaccination as a case study. Methods Specific equity-related indicators for vaccination were first mapped to the Guidance on Priority Setting in Health Care (GPS-Health) checklist criteria. Economic evaluations of rotavirus vaccine in LMICs identified via a systematic review of the literature were assessed to explore the extent to which equity was considered in the research objectives and analysis, and whether it was reflected in the evaluation results. Results The mapping process resulted in 18 unique indicators. Under the 'disease and intervention' criteria, severity of illness was incorporated in 75% of the articles, age distribution of the disease in 70%, and presence of comorbidities in 5%. For the 'social groups' criteria, relative coverage reflecting wealth-based coverage inequality was taken into account in 30% of the articles, geographic location in 27%, household income level in 8%, and sex at birth in 5%. For the criteria of 'protection against the financial and social effects of ill health', age weighting was incorporated in 43% of the articles, societal perspective in 58%, caregiver's loss of productivity in 45%, and financial risk protection in 5%. Overall, some articles incorporated the indicators in their model inputs (20%) while the majority (80%) presented results (costs, health outcomes, or incremental cost-effectiveness ratios) differentiated according to the indicators. Critically, less than a fifth (17%) of articles incorporating indicators did so due to an explicit study objective related to capturing equity considerations. Most indicators were increasingly incorporated over time, with a notable exception of age-weighting of DALYs. Conclusion Integrating equity criteria in CEA can help policy-makers better understand the distributional impact of health interventions. This study illustrates how equity considerations are currently being incorporated within CEA of rotavirus vaccination and highlights the components of equity that have been used in studies in LMICs. Areas for further improvement are identified.
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Affiliation(s)
| | | | - Kim Dalziel
- 3Centre for Health Policy, The University of Melbourne, Melbourne, Australia
| | - Natalie Carvalho
- 4Centre for Health Policy & Global Burden of Disease Group, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Riumallo-Herl C, Chang AY, Clark S, Constenla D, Clark A, Brenzel L, Verguet S. Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus and pneumococcal vaccines in low-income and middle-income countries: a modelling study. BMJ Glob Health 2018; 3:e000613. [PMID: 29662691 PMCID: PMC5898318 DOI: 10.1136/bmjgh-2017-000613] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/19/2018] [Accepted: 02/24/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Beyond their impact on health, vaccines can lead to large economic benefits. While most economic evaluations of vaccines have focused on the health impact of vaccines at a national scale, it is critical to understand how their impact is distributed along population subgroups. Methods We build a financial risk protection model to evaluate the impact of immunisation against measles, severe pneumococcal disease and severe rotavirus for birth cohorts vaccinated over 2016-2030 for three scenarios in 41 Gavi-eligible countries: no immunisation, current immunisation coverage forecasts and the current immunisation coverage enhanced with funding support. We distribute modelled disease cases per socioeconomic group and derive the number of cases of: (1) catastrophic health costs (CHCs) and (2) medical impoverishment. Results In the absence of any vaccine coverage, the number of CHC cases attributable to measles, severe pneumococcal disease and severe rotavirus would be approximately 18.9 million, 6.6 million and 2.2 million, respectively. Expanding vaccine coverage would reduce this number by up to 90%, 30% and 40% in each case. More importantly, we find a higher share of CHC incidence among the poorest quintiles who consequently benefit more from vaccine expansion. Conclusion Our findings contribute to the understanding of how vaccines can have a broad economic impact. In particular, we find that immunisation programmes can reduce the proportion of households facing catastrophic payments from out-of-pocket health expenses, mainly in lower socioeconomic groups. Thus, vaccines could have an important role in poverty reduction.
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Affiliation(s)
- Carlos Riumallo-Herl
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Applied Economics, Erasmus School of Economics, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - Angela Y Chang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Samantha Clark
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Logan Brenzel
- Bill and Melinda Gates Foundation, Washington DC, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X, Arreola-Ornelas H, Gómez-Dantés O, Rodriguez NM, Alleyne GAO, Connor SR, Hunter DJ, Lohman D, Radbruch L, Del Rocío Sáenz Madrigal M, Atun R, Foley KM, Frenk J, Jamison DT, Rajagopal MR. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet 2018; 391:1391-1454. [PMID: 29032993 DOI: 10.1016/s0140-6736(17)32513-8] [Citation(s) in RCA: 599] [Impact Index Per Article: 99.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Felicia Marie Knaul
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Coral Gables, FL, USA; Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL, USA; Tómatelo a Pecho, A.C., Mexico City, Mexico; Fundación Mexicana para la Salud, A.C., Mexico City, Mexico.
| | | | - Eric L Krakauer
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; World Health Organization, Geneva, Switzerland
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, TX, USA
| | - Afsan Bhadelia
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiaoxiao Jiang Kwete
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Héctor Arreola-Ornelas
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Tómatelo a Pecho, A.C., Mexico City, Mexico; Fundación Mexicana para la Salud, A.C., Mexico City, Mexico
| | | | - Natalia M Rodriguez
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA
| | - George A O Alleyne
- Pan American Health Organization, Regional Office of WHO, Washington, DC, USA
| | | | - David J Hunter
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Diederik Lohman
- Health and Human Rights Division, Human Rights Watch, Maplewood, NJ, USA
| | - Lukas Radbruch
- International Association for Hospice and Palliative Care, Houston, TX, USA; Department of Palliative Medicine, University Hospital Bonn, Germany; The Malteser Hospital, Bonn, Germany
| | | | - Rifat Atun
- Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Julio Frenk
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Coral Gables, FL, USA; School of Business Administration, University of Miami, Coral Gables, FL, USA
| | | | - M R Rajagopal
- Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Pallium India, Kerala, India
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Chang AY, Riumallo-Herl C, Perales NA, Clark S, Clark A, Constenla D, Garske T, Jackson ML, Jean K, Jit M, Jones EO, Li X, Suraratdecha C, Bullock O, Johnson H, Brenzel L, Verguet S. The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries. Health Aff (Millwood) 2018; 37:316-324. [PMID: 29401021 DOI: 10.1377/hlthaff.2017.0861] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With social policies increasingly directed toward enhancing equity through health programs, it is important that methods for estimating the health and economic benefits of these programs by subpopulation be developed, to assess both equity concerns and the programs' total impact. We estimated the differential health impact (measured as the number of deaths averted) and household economic impact (measured as the number of cases of medical impoverishment averted) of ten antigens and their corresponding vaccines across income quintiles for forty-one low- and middle-income countries. Our analysis indicated that benefits across these vaccines would accrue predominantly in the lowest income quintiles. Policy makers should be informed about the large health and economic distributional impact that vaccines could have, and they should view vaccination policies as potentially important channels for improving health equity. Our results provide insight into the distribution of vaccine-preventable diseases and the health benefits associated with their prevention.
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Affiliation(s)
- Angela Y Chang
- Angela Y. Chang ( ) was a doctor of science candidate in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts, at the time this article was completed. Currently she is a postdoctoral fellow at the Institute for Health Metrics and Evaluation, University of Washington, in Seattle
| | - Carlos Riumallo-Herl
- Carlos Riumallo-Herl was a doctor of science candidate in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, at the time this article was completed. Currently he is a postdoctoral fellow in the Department of Applied Economics, Erasmus School of Economics, in Rotterdam, the Netherlands
| | - Nicole A Perales
- Nicole A. Perales was a master of science student in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, at the time this article was completed. Currently she is a doctoral student at the University of California, Berkeley
| | - Samantha Clark
- Samantha Clark is a PhD candidate in the Pharmaceutical Outcomes Research and Policy Program, University of Washington
| | - Andrew Clark
- Andrew Clark is an assistant professor in health decision modelling, London School of Hygiene and Tropical Medicine, in the United Kingdom
| | - Dagna Constenla
- Dagna Constenla is an associate scientist and the director of Economics and Finance in the Vaccine Access Center of the Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Tini Garske
- Tini Garske is a lecturer in the MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, in the United Kingdom
| | - Michael L Jackson
- Michael L. Jackson is an associate investigator at the Kaiser Permanente Washington Health Research Institute, in Seattle
| | - Kévin Jean
- Kévin Jean is a lecturer in epidemiology in the laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des Arts et Métiers, in Paris, France, and a visiting lecturer in the MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London
| | - Mark Jit
- Mark Jit is a professor of vaccine epidemiology in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Edward O Jones
- Edward O. Jones was a researcher in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, when this article was completed
| | - Xi Li
- Xi Li is an independent health consultant in Manila, the Philippines
| | | | - Olivia Bullock
- Olivia Bullock is a program officer at Gavi, the Vaccine Alliance, in Geneva, Switzerland
| | - Hope Johnson
- Hope Johnson is director of monitoring and evaluation at Gavi, the Vaccine Alliance
| | - Logan Brenzel
- Logan Brenzel is a senior program officer for economics and finance, Vaccine Delivery/Global Development, Bill & Melinda Gates Foundation, in Washington, D.C
| | - Stéphane Verguet
- Stéphane Verguet is an assistant professor of global health in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health
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Dawkins BR, Mirelman AJ, Asaria M, Johansson KA, Cookson RA. Distributional cost-effectiveness analysis in low- and middle-income countries: illustrative example of rotavirus vaccination in Ethiopia. Health Policy Plan 2018; 33:456-463. [DOI: 10.1093/heapol/czx175] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bryony R Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK,
| | - Andrew J Mirelman
- Centre for Health Economics, Alcuin 'A' Block, University of York, Heslington YO10 5DD, United Kingdom,
| | - Miqdad Asaria
- Centre for Health Economics, Alcuin 'A' Block, University of York, Heslington YO10 5DD, United Kingdom,
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen Postboks 7804, N-5020 Bergen, Norway and
- Department of Addiction Medicine, Haukeland University Hospital, Kalfarveien 31, 5020 Bergen, Norway
| | - Richard A Cookson
- Centre for Health Economics, Alcuin 'A' Block, University of York, Heslington YO10 5DD, United Kingdom,
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Nonvignon J, Atherly D, Pecenka C, Aikins M, Gazley L, Groman D, Narh CT, Armah G. Cost-effectiveness of rotavirus vaccination in Ghana: Examining impacts from 2012 to 2031. Vaccine 2017; 36:7215-7221. [PMID: 29223486 PMCID: PMC6238184 DOI: 10.1016/j.vaccine.2017.11.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 12/26/2022]
Abstract
Ghana is currently transitioning away from Gavi support. Thus, cost-effectiveness is crucial for improving health system efficiency. Rotavirus vaccination brings health and economic benefits to Ghana. Rotavirus vaccination is highly cost-effective in Ghana, even Gavi transition.
Background Diarrhea causes about 10% of all deaths in children under five years globally, with rotavirus causing about 40% of all diarrhea deaths. Ghana introduced rotavirus vaccination as part of routine immunization in 2012 and it has been shown to be effective in reducing disease burden in children under five years. Ghana’s transition from low to lower-middle income status in 2010 implies fewer resources from Gavi as well as other major global financing mechanisms. Ghana will soon bear the full cost of vaccines. The aim of this study was to estimate the health impact, costs and cost-effectiveness of rotavirus vaccination in Ghana from introduction and beyond the Gavi transition. Methods The TRIVAC model is used to estimate costs and effects of rotavirus vaccination from 2012 through 2031. Model inputs include demographics, disease burden, health system structure, health care utilization and costs as well as vaccine cost, coverage, and efficacy. Model inputs came from local data, the international literature and expert consultation. Costs were examined from the health system and societal perspectives. Results The results show that continued rotavirus vaccination could avert more than 2.2 million cases and 8900 deaths while saving US$6 to US$9 million in costs over a 20-year period. The net cost of vaccination program is approximately US$60 million over the same period. The societal cost per DALY averted is US$238 to US$332 with cost per case averted ranging from US$27 to US$38. The cost per death averted is approximately US$7000. Conclusion The analysis shows that continued rotavirus vaccination will be highly cost-effective, even for the period during which Ghana will assume responsibility for purchasing vaccines after transition from Gavi support.
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Affiliation(s)
| | | | | | - Moses Aikins
- School of Public Health, University of Ghana, Legon, Ghana
| | | | | | - Clement T Narh
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - George Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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Vaillancourt A, Tatham P, Wu Y, Haavisto I. Humanitarian health project supply chain costs. SUPPLY CHAIN FORUM 2017. [DOI: 10.1080/16258312.2017.1394775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alain Vaillancourt
- Business Administration, Jönköping International Business School, Jönköping, Sweden
| | - Peter Tatham
- International Business and Asian Studies, Griffith University, Gold Coast, Australia
| | - Yong Wu
- International Business and Asian Studies, Griffith University, Gold Coast, Australia
| | - Ira Haavisto
- Supply Chain Management and Social Responsibility, Hanken School of Economics, Helsinki, Finland
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Gessner BD, Kaslow D, Louis J, Neuzil K, O'Brien KL, Picot V, Pang T, Parashar UD, Saadatian-Elahi M, Nelson CB. Estimating the full public health value of vaccination. Vaccine 2017; 35:6255-6263. [PMID: 28986035 DOI: 10.1016/j.vaccine.2017.09.048] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 12/18/2022]
Abstract
There is an enhanced focus on considering the full public health value (FPHV) of vaccination when setting priorities, making regulatory decisions and establishing implementation policy for public health activities. Historically, a therapeutic paradigm has been applied to the evaluation of prophylactic vaccines and focuses on an individual benefit-risk assessment in prospective and individually-randomized phase III trials to assess safety and efficacy against etiologically-confirmed clinical outcomes. By contrast, a public health paradigm considers the population impact and encompasses measures of community benefits against a range of outcomes. For example, measurement of the FPHV of vaccination may incorporate health inequity, social and political disruption, disruption of household integrity, school absenteeism and work loss, health care utilization, long-term/on-going disability, the development of antibiotic resistance, and a range of non-etiologically and etiologically defined clinical outcomes. Following an initial conference at the Fondation Mérieux in mid-2015, a second conference (December 2016) was held to further describe the efficacy of using the FPHV of vaccination on a variety of prophylactic vaccines. The wider scope of vaccine benefits, improvement in risk assessment, and the need for partnership and coalition building across interventions has also been discussed during the 2014 and 2016 Global Vaccine and Immunization Research Forums and the 2016 Geneva Health Forum, as well as in numerous publications including a special issue of Health Affairs in February 2016. The December 2016 expert panel concluded that while progress has been made, additional efforts will be necessary to have a more fully formulated assessment of the FPHV of vaccines included into the evidence-base for the value proposition and analysis of unmet medical need to prioritize vaccine development, vaccine licensure, implementation policies and financing decisions. The desired outcomes of these efforts to establish an alternative framework for vaccine evaluation are a more robust vaccine pipeline, improved appreciation of vaccine value and hence of its relative affordability, and greater public access and acceptance of vaccines.
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Affiliation(s)
| | | | - Jacques Louis
- Fondation Mérieux, 17 rue Bourgelat, 69002 Lyon, France
| | - Kathleen Neuzil
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Katherine L O'Brien
- Department of International Health & Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | | | - Tikki Pang
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - Umesh D Parashar
- Division of Viral Diseases, US Centres for Disease Control and Prevention, Atlanta, GA, United States
| | - Mitra Saadatian-Elahi
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, 5 Place d'Arsonval, 69437 Lyon cedex 03, France
| | - Christopher B Nelson
- Sanofi Pasteur, Vaccination Policy Department, 2 Avenue du Pont Pasteur, 69367 Lyon cedex 07, France
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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.
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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
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Johansson KA, Strand KB, Fekadu A, Chisholm D. Health Gains and Financial Protection Provided by the Ethiopian Mental Health Strategy: an Extended Cost-Effectiveness Analysis. Health Policy Plan 2017; 32:376-383. [PMID: 27935798 PMCID: PMC5400039 DOI: 10.1093/heapol/czw134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mental and neurological (MN) health care has long been neglected in low-income settings. This paper estimates health and non-health impacts of fully publicly financed care for selected key interventions in the National Mental Health Strategy in Ethiopia for depression, bipolar disorder, schizophrenia and epilepsy. METHODS A methodology of extended cost-effectiveness analysis (ECEA) is applied to MN health care in Ethiopia. The impact of providing a package of selected MN interventions free of charge in Ethiopia is estimated for: epilepsy (75% coverage, phenobarbital), depression (30% coverage, fluoxetine, cognitive therapy and proactive case management), bipolar affective disorder (50% coverage, valproate and psychosocial therapy) and schizophrenia (75% coverage, haloperidol plus psychosocial treatment). Multiple outcomes are estimated and disaggregated across wealth quintiles: (1) healthy-life-years (HALYs) gained; (2) household out-of-pocket (OOP) expenditures averted; (3) expected financial risk protection (FRP); and (4) productivity impact. RESULTS The MN package is expected to cost US$177 million and gain 155,000 HALYs (epilepsy US$37m and 64,500 HALYs; depression US$65m and 61,300 HALYs; bipolar disorder US$44m and 20,300 HALYs; and schizophrenia US$31m and 8,900 HALYs) annually. The health benefits would be concentrated among the poorest groups for all interventions. Universal public finance averts little household OOP expenditures and provides minimal FRP because of the low current utilization of these MN services in Ethiopia. In addition, economic benefits of US$ 51 million annually are expected from depression treatment in Ethiopia as a result of productivity gains, equivalent to 78% of the investment cost. CONCLUSIONS The total MN package in Ethiopia is estimated to cost equivalent to US$1.8 per capita and yields large progressive health benefits. The expected productivity gain is substantially higher than the expected FRP. The ECEA approach seems to fit well with the current policy challenges and captures important equity concerns of scaling up MN programmes.
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Affiliation(s)
- Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Abebaw Fekadu
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, London, UK
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva
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Cookson R, Mirelman AJ, Griffin S, Asaria M, Dawkins B, Norheim OF, Verguet S, J Culyer A. Using Cost-Effectiveness Analysis to Address Health Equity Concerns. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:206-212. [PMID: 28237196 PMCID: PMC5340318 DOI: 10.1016/j.jval.2016.11.027] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/09/2016] [Accepted: 11/28/2016] [Indexed: 05/22/2023]
Abstract
This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health-the objective underpinning conventional CEA-and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and-crucially-who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.
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Affiliation(s)
| | | | - Susan Griffin
- Centre for Health Economics, University of York, York, UK
| | - Miqdad Asaria
- Centre for Health Economics, University of York, York, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard University, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Garrison LP, Kamal-Bahl S, Towse A. Toward a Broader Concept of Value: Identifying and Defining Elements for an Expanded Cost-Effectiveness Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:213-216. [PMID: 28237197 DOI: 10.1016/j.jval.2016.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 05/19/2023]
Abstract
This commentary identifies and defines potentially useful expansions to traditional cost-effectiveness analysis as often used in health technology assessment. Since the seminal 1977 article by Weinstein and Stason, the recommended approach has been the use of the incremental cost-effectiveness ratio based on the metric of the cost per quality-adjusted life-year gained, allowing comparisons across different technologies. An expanded framework, incorporating a wider range of the elements of value, is proposed. In addition to the core value drivers of health gain and other health system cost savings (if any), we propose adding other less recognized elements related to the value of knowing and informational externalities. We describe each of five factors related to the value of knowing: 1) a reduction in uncertainty, reflecting the benefit of a companion diagnostic increasing the certainty of a patient׳s response to a medicine; 2) insurance value related to greater peace of mind due to protection against catastrophic health and financial loss; 3) the value of hope for a "cure," leading individuals to become risk seekers in some circumstances; 4) real option value due to life extension opening possibilities for individuals to benefit from future innovation; and 5) spillovers or externalities arising from benefits of scientific advances that cannot be entirely appropriated by those making the advances. Further thought and research are needed on how best to measure and integrate these elements into an incremental value framework and on coverage and pricing decisions.
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Shrime MG, Sekidde S, Linden A, Cohen JL, Weinstein MC, Salomon JA. Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda. PLoS One 2016; 11:e0168867. [PMID: 28036357 PMCID: PMC5201287 DOI: 10.1371/journal.pone.0168867] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/06/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. METHODS Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. FINDINGS Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term "surgical mission trip". These results are robust to scenario and sensitivity analyses. INTERPRETATION The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems.
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Affiliation(s)
- Mark G. Shrime
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, United States of America
| | - Serufusa Sekidde
- Aspen Global Health and Development, Aspen Institute, Aspen, CO, United States of America
| | - Allison Linden
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Jessica L. Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Milton C. Weinstein
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Joshua A. Salomon
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Loganathan T, Jit M, Hutubessy R, Ng CW, Lee WS, Verguet S. Rotavirus vaccines contribute towards universal health coverage in a mixed public-private healthcare system. Trop Med Int Health 2016; 21:1458-1467. [PMID: 27503549 DOI: 10.1111/tmi.12766] [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: 11/29/2022]
Abstract
OBJECTIVES To evaluate rotavirus vaccination in Malaysia from the household's perspective. The extended cost-effectiveness analysis (ECEA) framework quantifies the broader value of universal vaccination starting with non-health benefits such as financial risk protection and equity. These dimensions better enable decision-makers to evaluate policy on the public finance of health programmes. METHODS The incidence, health service utilisation and household expenditure related to rotavirus gastroenteritis according to national income quintiles were obtained from local data sources. Multiple birth cohorts were distributed into income quintiles and followed from birth over the first five years of life in a multicohort, static model. RESULTS We found that the rich pay more out of pocket (OOP) than the poor, as the rich use more expensive private care. OOP payments among the poorest although small are high as a proportion of household income. Rotavirus vaccination results in substantial reduction in rotavirus episodes and expenditure and provides financial risk protection to all income groups. Poverty reduction benefits are concentrated amongst the poorest two income quintiles. CONCLUSION We propose that universal vaccination complements health financing reforms in strengthening Universal Health Coverage (UHC). ECEA provides an important tool to understand the implications of vaccination for UHC, beyond traditional considerations of economic efficiency.
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Affiliation(s)
- Tharani Loganathan
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mark Jit
- Modeling and Economics Unit, Public Health England, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Chiu-Wan Ng
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Julius Centre University of Malaya, University of Malaya, Kuala Lumpur, Malaysia
| | - Way-Seah Lee
- Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Paediatrics and Child Health Research Group, Kuala Lumpur, Malaysia
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Verguet S, Kim JJ, Jamison DT. Extended Cost-Effectiveness Analysis for Health Policy Assessment: A Tutorial. PHARMACOECONOMICS 2016; 34:913-23. [PMID: 27374172 PMCID: PMC4980400 DOI: 10.1007/s40273-016-0414-z] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Health policy instruments such as the public financing of health technologies (e.g., new drugs, vaccines) entail consequences in multiple domains. Fundamentally, public health policies aim at increasing the uptake of effective and efficient interventions and at subsequently leading to better health benefits (e.g., premature mortality and morbidity averted). In addition, public health policies can provide non-health benefits in addition to the sole well-being of populations and beyond the health sector. For instance, public policies such as social and health insurance programs can prevent illness-related impoverishment and procure financial risk protection. Furthermore, public policies can improve the distribution of health in the population and promote the equalization of health among individuals. Extended cost-effectiveness analysis was developed to address health policy assessment, specifically to evaluate the health and financial consequences of public policies in four domains: (1) the health gains; (2) the financial risk protection benefits; (3) the total costs to the policy makers; and (4) the distributional benefits. Here, we present a tutorial that describes both the intent of extended cost-effectiveness analysis and its keys to allow easy implementation for health policy assessment.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jane J Kim
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dean T Jamison
- Global Health Sciences, University of California, San Francisco, CA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Nandi A, Megiddo I, Ashok A, Verma A, Laxminarayan R. Reduced burden of childhood diarrheal diseases through increased access to water and sanitation in India: A modeling analysis. Soc Sci Med 2016; 180:181-192. [PMID: 27614366 DOI: 10.1016/j.socscimed.2016.08.049] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 08/23/2016] [Accepted: 08/27/2016] [Indexed: 10/21/2022]
Abstract
Each year, more than 300,000 children in India under the age of five years die from diarrheal diseases. Clean piped water and improved sanitation are known to be effective in reducing the mortality and morbidity burden of diarrhea but are not yet available to close to half of the Indian population. In this paper, we estimate the health benefits (reduced cases of diarrheal incidence and deaths averted) and economic benefits (measured by out-of-pocket treatment expenditure averted and value of insurance gained) of scaling up the coverage of piped water and improved sanitation among Indian households to a near-universal 95% level. We use IndiaSim, a previously validated, agent-based microsimulation platform to model disease progression and individual demographic and healthcare-seeking behavior in India, and use an iterative, stochastic procedure to simulate health and economic outcomes over time. We find that scaling up access to piped water and improved sanitation could avert 43,352 (95% uncertainty range [UR] 42,201-44,504) diarrheal episodes and 68 (95% UR 62-74) diarrheal deaths per 100,000 under-5 children per year, compared with the baseline. We estimate a saving of (in 2013 US$) $357,788 (95% $345,509-$370,067) in out-of-pocket diarrhea treatment expenditure, and $1646 (95% UR $1603-$1689) in incremental value of insurance per 100,000 under-5 children per year over baseline. The health and financial benefits are highly progressive, i.e. they reach poorer households more. Thus, scaling up access to piped water and improved sanitation can lead to large and equitable reductions in the burden of childhood diarrheal diseases in India.
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Affiliation(s)
- Arindam Nandi
- Center for Disease Dynamics, Economics & Policy, 1400 Eye St NW, Ste 500, Washington DC, 20005, USA; Public Health Foundation of India, Gurgaon, India.
| | - Itamar Megiddo
- Center for Disease Dynamics, Economics & Policy, 1400 Eye St NW, Ste 500, Washington DC, 20005, USA; Department of Management Science, University of Strathclyde, Glasgow, UK.
| | - Ashvin Ashok
- Center for Disease Dynamics, Economics & Policy, 1400 Eye St NW, Ste 500, Washington DC, 20005, USA.
| | - Amit Verma
- Center for Disease Dynamics, Economics & Policy, 1400 Eye St NW, Ste 500, Washington DC, 20005, USA.
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, 1400 Eye St NW, Ste 500, Washington DC, 20005, USA; Princeton University, Princeton, NJ, USA; Public Health Foundation of India, Gurgaon, India.
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Colombini A, Trotter C, Madrid Y, Karachaliou A, Preziosi MP. Costs of Neisseria meningitidis Group A Disease and Economic Impact of Vaccination in Burkina Faso. Clin Infect Dis 2016; 61 Suppl 5:S473-82. [PMID: 26553677 PMCID: PMC4639502 DOI: 10.1093/cid/civ600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background. Five years since the successful introduction of MenAfriVac in a mass vaccination campaign targeting 1- to 29-year-olds in Burkina Faso, consideration must be given to the optimal strategies for sustaining population protection. This study aims to estimate the economic impact of a range of vaccination strategies in Burkina Faso. Methods. We performed a cost-of-illness study, comparing different vaccination scenarios in terms of costs to both households and health systems over a 26-year time horizon. These scenarios are (1) reactive vaccination campaign (baseline comparator); (2) preventive vaccination campaign; (3) routine immunization at 9 months; and (4) a combination of routine and an initial catchup campaign of children under 5. Costs were estimated from a literature review, which included unpublished programmatic documents and peer-reviewed publications. The future disease burden for each vaccination strategy was predicted using a dynamic transmission model of group A Neisseria meningitidis. Results. From 2010 to 2014, the total costs associated with the preventive campaign targeting 1- to 29-year-olds with MenAfriVac were similar to the estimated costs of the reactive vaccination strategy (approximately 10 million US dollars [USD]). Between 2015 and 2035, routine immunization with or without a catch-up campaign of 1- to 4-year-olds is cost saving compared with the reactive strategy, both with and without discounting costs and cases. Most of the savings are accrued from lower costs of case management and household costs resulting from a lower burden of disease. After the initial investment in the preventive strategy, 1 USD invested in the routine strategy saves an additional 1.3 USD compared to the reactive strategy. Conclusions. Prevention strategies using MenAfriVac will be significantly cost saving in Burkina Faso, both for the health system and for households, compared with the reactive strategy. This will protect households from catastrophic expenditures and increase the development capacity of the population.
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Affiliation(s)
- Anaïs Colombini
- Independent Consultant, World Health Organization Initiative for Vaccine Research, Geneva, Switzerland
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
| | | | - Andromachi Karachaliou
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
| | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
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Younger DS, Younger APJ, Guttmacher S. Childhood Vaccination: Implications for Global and Domestic Public Health. Neurol Clin 2016; 34:1035-1047. [PMID: 27719987 DOI: 10.1016/j.ncl.2016.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The role of vaccination in the control and prevention of endemic and emerging diseases cannot be overemphasized. Induction of host protective immunity may be the most powerful tool and effective strategy in preventing the spread of potentially fatal disease and emerging illnesses, in particular in susceptible immunologically naive hosts. The strategy for vaccination programs is engrained in population studies recognizing benefit for the health and economic welfare of at-risk indigenous populations. Worldwide collaboration is a necessary aspect of vaccine-preventable diseases recognizing that even a small number of wild-type cases of an eradicated disease in one region presents opportunities for re-emergence of the disease in geographically remote areas.
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Affiliation(s)
- David S Younger
- Division of Neuroepidemiology, Department of Neurology, New York University School of Medicine, New York, NY, USA; College of Global Public Health, New York University, New York, NY, USA.
| | - Adam P J Younger
- Public and Nonprofit Management and Policy, The Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Sally Guttmacher
- College of Global Public Health, New York University, New York, NY, USA
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