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Conteh L, Shuford K, Agboraw E, Kont M, Kolaczinski J, Patouillard E. Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1213-1222. [PMID: 34372987 PMCID: PMC8324482 DOI: 10.1016/j.jval.2021.01.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To systematically review the literature on the unit cost and cost-effectiveness of malaria control. METHODS Ten databases and gray literature sources were searched to identify evidence relevant to the period 2005 to 2018. Studies with primary financial or economic cost data from malaria endemic countries that took a provider, provider and household, or societal perspective were included. RESULTS We identified 103 costing studies. The majority of studies focused on individual rather than combined interventions, notably insecticide-treated bed nets and treatment, and commonly took a provider perspective. A third of all studies took place in 3 countries. The median provider economic cost of protecting 1 person per year ranged from $1.18 to $5.70 with vector control and from $0.53 to $5.97 with chemoprevention. The median provider economic cost per case diagnosed with rapid diagnostic tests was $6.06 and per case treated $9.31 or $89.93 depending on clinical severity. Other interventions did not share enough similarities to be summarized. Cost drivers were rarely reported. Cost-effectiveness of malaria control was reiterated, but care in methodological and reporting standards is required to enhance data transferability. CONCLUSIONS Important information that can support resource allocation was reviewed. Given the variability in methods and reporting, global efforts to follow existing standards are required for the evidence to be most useful outside their study context, supplemented by guidance on options for transferring existing data across settings.
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Affiliation(s)
- Lesong Conteh
- Department of Health Policy, London School of Economics and Political Science, London, England, UK; School of Public Health, Imperial College London, St Mary's Campus, Paddington, England, UK
| | - Kathryn Shuford
- Department of Health Policy, London School of Economics and Political Science, London, England, UK
| | - Efundem Agboraw
- Vector Biology, Liverpool School of Tropical Medicine, Liverpool, England, UK
| | - Mara Kont
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, Imperial College London, England, UK
| | - Jan Kolaczinski
- Department of the Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Edith Patouillard
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland.
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Kim JH, Suh J, Lee WJ, Choi H, Kim JD, Kim C, Choi JY, Ko R, Kim H, Lee J, Yeom JS. Modelling the impact of rapid diagnostic tests on Plasmodium vivax malaria in South Korea: a cost-benefit analysis. BMJ Glob Health 2021; 6:bmjgh-2020-004292. [PMID: 33593755 PMCID: PMC7888375 DOI: 10.1136/bmjgh-2020-004292] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/21/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
Background Rapid diagnostic tests (RDTs) are widely used for diagnosing Plasmodium vivax malaria, especially in resource-limited countries. However, the impact of RDTs on P. vivax malaria incidence and national medical costs has not been evaluated. We assessed the impact of RDT implementation on P. vivax malaria incidence and overall medical expenditures in South Korea and performed a cost–benefit analysis from the payer’s perspective. Methods We developed a dynamic compartmental model for P. vivax malaria transmission in South Korea using delay differential equations. Long latency and seasonality were incorporated into the model, which was calibrated to civilian malaria incidences during 2014–2018. We then estimated averted malaria cases and total medical costs from two diagnostic scenarios: microscopy only and both microscopy and RDTs. Medical costs were extracted based on data from a hospital in an at-risk area for P. vivax malaria and were validated using Health Insurance Review and Assessment Service data. We conducted a cost–benefit analysis of RDTs using the incremental benefit:cost ratio (IBCR) considering only medical costs and performed a probabilistic sensitivity analysis to reflect the uncertainties of model parameters, costs and benefits. Results The results showed that 55.3% of new P. vivax malaria cases were averted, and $696 214 in medical costs was saved over 10 years after RDT introduction. The estimated IBCR was 2.5, indicating that RDT implementation was beneficial, compared with microscopy alone. The IBCR was sensitive to the diagnosis time reduction, infectious period and short latency period, and provided beneficial results in a benefit over $10.6 or RDT cost under $39.7. Conclusions The model simulation suggested that RDTs could significantly reduce P. vivax malaria incidence and medical costs. Moreover, cost–benefit analysis demonstrated that the introduction of RDTs was beneficial over microscopy alone. These results support the need for widespread adoption of RDTs.
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Affiliation(s)
- Jung Ho Kim
- Department of Internal Medicine, AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jiyeon Suh
- School of Mathematics and Computing (Computational Science and Engineering), Yonsei University, Seoul, South Korea
| | - Woon Ji Lee
- Department of Internal Medicine, AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Heun Choi
- Department of Internal Medicine, National Health Insurance Service Ilsan hospital, Goyang, South Korea
| | - Jong-Dae Kim
- Department of General Surgery, Bestian Woosong Hospital, Daejeon, South Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Yong Choi
- Department of Internal Medicine, AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Ryeojin Ko
- Department of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Heewon Kim
- Department of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Jeehyun Lee
- School of Mathematics and Computing, Yonsei University, Seoul, South Korea
| | - Joon Sup Yeom
- Department of Internal Medicine, AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Devine A, Battle KE, Meagher N, Howes RE, Dini S, Gething PW, Simpson JA, Price RN, Lubell Y. Global economic costs due to vivax malaria and the potential impact of its radical cure: A modelling study. PLoS Med 2021; 18:e1003614. [PMID: 34061843 PMCID: PMC8168905 DOI: 10.1371/journal.pmed.1003614] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/07/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In 2017, an estimated 14 million cases of Plasmodium vivax malaria were reported from Asia, Central and South America, and the Horn of Africa. The clinical burden of vivax malaria is largely driven by its ability to form dormant liver stages (hypnozoites) that can reactivate to cause recurrent episodes of malaria. Elimination of both the blood and liver stages of the parasites ("radical cure") is required to achieve a sustained clinical response and prevent ongoing transmission of the parasite. Novel treatment options and point-of-care diagnostics are now available to ensure that radical cure can be administered safely and effectively. We quantified the global economic cost of vivax malaria and estimated the potential cost benefit of a policy of radical cure after testing patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency. METHODS AND FINDINGS Estimates of the healthcare provider and household costs due to vivax malaria were collated and combined with national case estimates for 44 endemic countries in 2017. These provider and household costs were compared with those that would be incurred under 2 scenarios for radical cure following G6PD screening: (1) complete adherence following daily supervised primaquine therapy and (2) unsupervised treatment with an assumed 40% effectiveness. A probabilistic sensitivity analysis generated credible intervals (CrIs) for the estimates. Globally, the annual cost of vivax malaria was US$359 million (95% CrI: US$222 to 563 million), attributable to 14.2 million cases of vivax malaria in 2017. From a societal perspective, adopting a policy of G6PD deficiency screening and supervision of primaquine to all eligible patients would prevent 6.1 million cases and reduce the global cost of vivax malaria to US$266 million (95% CrI: US$161 to 415 million), although healthcare provider costs would increase by US$39 million. If perfect adherence could be achieved with a single visit, then the global cost would fall further to US$225 million, equivalent to $135 million in cost savings from the baseline global costs. A policy of unsupervised primaquine reduced the cost to US$342 million (95% CrI: US$209 to 532 million) while preventing 2.1 million cases. Limitations of the study include partial availability of country-level cost data and parameter uncertainty for the proportion of patients prescribed primaquine, patient adherence to a full course of primaquine, and effectiveness of primaquine when unsupervised. CONCLUSIONS Our modelling study highlights a substantial global economic burden of vivax malaria that could be reduced through investment in safe and effective radical cure achieved by routine screening for G6PD deficiency and supervision of treatment. Novel, low-cost interventions for improving adherence to primaquine to ensure effective radical cure and widespread access to screening for G6PD deficiency will be critical to achieving the timely global elimination of P. vivax.
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Affiliation(s)
- Angela Devine
- Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine E. Battle
- Institute for Disease Modeling, Seattle, Washington, United States of America
| | - Niamh Meagher
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory Epidemiology Unit, Royal Melbourne Hospital, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Rosalind E. Howes
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
- Oxford Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Saber Dini
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter W. Gething
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- Curtin University, Bentley, Western Australia, Australia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ric N. Price
- Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Yoel Lubell
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
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Hu J, Zhang C, Wang S, Chen X, Hu J, Liu X. Accuracy of rapid diagnostic test to diagnose malaria in children under 5 years of age, a meta-analysis. Diagn Microbiol Infect Dis 2021; 100:115351. [PMID: 33743294 DOI: 10.1016/j.diagmicrobio.2021.115351] [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: 11/29/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the accuracy of the rapid diagnostic test for malaria diagnosis in children under 5 years of age. METHODS As of August 31, 2020, PubMed, Web of Science and Cochrane Library databases had been systematically searched. Relevant data were extracted and meta-analysis was carried out. A random effects model was used for subgroup analysis. RESULTS According to the inclusion criteria, a total of 26 studies were included in this meta-analysis. The pooled sensitivity and specificity were 0.92 (95% confidence interval 0.83-0.96) and 0.92 (0.86-0.95), the parasite-specific lactate dehydrogenase-based test were 0.96 (0.85-0.98) and 0.93 (0.86-0.95), the histidine-rich protein 2-based test were 0.94 (0.84-0.98) and 0.86 (0.77-0.91). CONCLUSIONS This meta-analysis showed that rapid diagnostic test had good accuracy in diagnosing malaria in children under 5 years of age. And the diagnostic performance of parasite-specific lactate dehydrogenase test was better than that of the histidine-rich protein 2 test.
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Affiliation(s)
- Junjun Hu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Chenyang Zhang
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Song Wang
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Xiaofei Chen
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jiayi Hu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Xin Liu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin Province, China.
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Du YQ, Ling XX, Jin JJ, Zhou HY, Zhu S, Zhu GD, Wang W, Cao J, Huang JY. Cost-effectiveness analysis of malaria rapid diagnostic test in the elimination setting. Infect Dis Poverty 2020; 9:135. [PMID: 32993762 PMCID: PMC7523355 DOI: 10.1186/s40249-020-00745-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND As more and more countries approaching the goal of malaria elimination, malaria rapid diagnostic tests (RDT) was recomendated to be a diagnostic strategy to achieve and maintain the statute of malaria free, as it's less requirments on equipment and experitise than microscopic examination. But there are very few economic evaluations to confirm whether RDT was cost-effective in the setting of malaria elimination. This research aimed to offer evidence for helping decision making on malaria diagnosis strategy. METHODS A cost-effectiveness analysis was conducted to compare RDT with microscopy examination for malaria diagnosis, by using a decision tree model. There were three strategies of malaria diagnostic testing evaluated in the model, 1) microscopy, 2) RDT, 3) RDT followed by microscopy. The effect indicator was defined as the number of malaria cases treated appropriately. Based on the joint perspective of health sector and patient, costs data were collected from hospital information systems, key informant interviews, and patient surveys. Data collection was conducted in Jiangsu from September 2018 to January 2019. Epidemiological data were obtained from local malaria surveillance reports. A hypothetical cohort of 300 000 febrile patients were simulated to calculate the total cost and effect of each strategy. One-way, two-way, and probabilistic sensitivity analysis were performed to test the robustness of the result. RESULTS The results showed that RDT strategy was the most effective (245 cases) but also the most costly (United States Dollar [USD] 4.47 million) compared to using microscopy alone (238 cases, USD 3.63 million), and RDT followed by microscopy (221 cases, USD 2.75 million). There was no strategy dominated. One-way sensitivity analysis reflected that the result was sensitive to the change in labor cost and two-way sensitivity analysis indicated that the result was not sensitive to the proportion of falciparum malaria. The result of Monte Carlo simulation showed that RDT strategy had higher effects and higher cost than other strategies with a high probability. CONCLUSIONS Compared to microscopy and RDT followed by microscopy, RDT strategy had higher effects and higher cost in the setting of malaria elimination.
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Affiliation(s)
- Yan-Qiu Du
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, 200433, China
| | - Xiao-Xiao Ling
- Department of Statistical Science, University College London, WC1E 6BT, London, UK
| | - Jia-Jie Jin
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, 200433, China
| | - Hua-Yun Zhou
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory of Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Si Zhu
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, 200433, China
| | - Guo-Ding Zhu
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory of Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.,Public Health Research Center, Jiangnan University, Wuxi, 214122, China
| | - Wei Wang
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, 200433, China
| | - Jun Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory of Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China. .,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China. .,Public Health Research Center, Jiangnan University, Wuxi, 214122, China.
| | - Jia-Yan Huang
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, 200433, China.
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Tsehay S, Hassen F, Hirigo AT, Abiy Z, Desta K. Blood transfusion-transmissible malaria and its cost analysis in Hawassa regional blood bank, Southern Ethiopia. SAGE Open Med 2020; 8:2050312120936930. [PMID: 32647577 PMCID: PMC7328218 DOI: 10.1177/2050312120936930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Blood transfusion is an intervention used to save life particularly for those
patients who survive only with receiving blood. Establishing effective
diagnostic test menus concerning the screening of transfusion-transmissible
infections in the blood banks play a vital role to safeguard recipients from
transfusion-transmissible infections. Objective: The aim of this study was to assess blood transfusion-transmissible malaria
and its screening cost analysis in Hawassa regional blood bank, Hawassa,
Sothern Ethiopia. Methods: An institutional-based cross-sectional study was conducted from April to May
2018 among 414 voluntary blood donors. Each participant’s blood sample was
screened for most transfusion-transmissible infections using
antigen/antibody tests, while rapid diagnostic test and microscopy were used
for malaria screening and confirmation. In addition, the cost screening of
transfusion-transmissible infections was calculated using activity-based
costing method. Results: The overall seropositivity of transfusion-transmissible infections was 7.0%
and the positivity rate of hepatitis B virus, syphilis, and
Plasmodium falciparum was 5.6%, 1.0%, and 0.5%,
respectively. The cost per test of each transfusion-transmissible infection
was US$5.04 for human immunodeficiency virus, US$4.61 for hepatitis B virus,
US$5.11 for hepatitis C virus, and US$4.75 for syphilis, while the cost per
test of malaria rapid diagnostic test was US$4.74 and this is comparatively
lower than the cost per test of other transfusion-transmissible infections
except for hepatitis B virus. In addition, total cost of laboratory incurred
for transfusion-transmissible infections screening is estimated to be
US$213,634.5 per year, while it becomes US$265,537.5 if the malaria
screening cost is added. This means 19.54% of the total cost of laboratory
incurred per year or US$51,903. Conclusion: The positivity rate of malaria parasites among voluntary blood donors was
0.5%, and it might be increased if the study was conducted in high
transmission seasons. A cost of malaria screening is comparatively lower
than costs of other transfusion-transmissible infections except for
hepatitis B virus. Therefore, the screening of malaria parasites should be
considered as one of the test menus of transfusion-transmissible infections
in blood banks, especially in malaria-endemic areas.
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Affiliation(s)
- Seblewongel Tsehay
- Hawassa University Comprehensive Specialized Hospital, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Fatuma Hassen
- Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Agete Tadewos Hirigo
- School of Medical Laboratory Sciences, College of Medicine and Health Science, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia
| | - Zinegnaw Abiy
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kassu Desta
- Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
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Neotropical Anopheles (Kerteszia) mosquitoes associated with bromeliad-malaria transmission in a changing world. Acta Trop 2020; 205:105413. [PMID: 32088278 DOI: 10.1016/j.actatropica.2020.105413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/06/2020] [Accepted: 02/19/2020] [Indexed: 01/17/2023]
Abstract
Kerteszia is a neotropical subgenus of Anopheles composed of 12 species. The species in this subgenus are strongly associated with humid forests rich in epiphytic bromeliads. Forest fragmentation and anthropogenic changes can therefore have a negative impact on the abundance and survival of these mosquito species. Within this subgenus, four species are considered primary vectors of malaria: An. cruzii, An. bellator, An. homunculus and An. neivai. Malaria cases associated with Kerteszia species are often referred to as bromeliad malaria, a type of malaria reported to be endemic in the coastal rainforest of the neotropical region since the end of the nineteenth century. Although the incidence of bromeliad-malaria cases has decreased since the middle of the last century, autochthonous malaria cases continue to be registered every year. The complexity of the epidemiology of bromeliad malaria appears to be increasing as asymptomatic plasmodial infections and transmission of simian Plasmodium to humans have recently been reported. Kerteszia vector species have a great affinity for human beings and can be found in human-modified areas close to forest fragments such as in the Extra-Amazonian region of Brazil, Colombian pacific coast, and the Caribbean coast. Deforestation and forest fragmentation have been occurring continuously in the biomes of the neotropical region, and findings of Kerteszia species in dwellings are frequent in this region. Controlling the species in the Kerteszia subgenus is particularly difficult because they move frequently from natural to rural and peri-urban areas in search of blood sources, posing a challenge for the development of control strategies based on integrated vector management. Furthermore, as it has been shown that some Kerteszia species share similar morphological and genetic characteristics, the existence of a species complex formed by cryptic, sibling species within the Kerteszia group in different areas in the South and Southeast of Brazil cannot be ruled out. The existence of such a complex could represent an obstacle to the control of Kerteszia species and consequently to the elimination of bromeliad-malaria transmission in these regions. Here, we review publications that focus on the biology and ecology of Kerteszia malaria vectors and their association with human-modified areas and bromeliad-malaria transmission.
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Ling XX, Jin JJ, Zhu GD, Wang WM, Cao YY, Yang MM, Zhou HY, Cao J, Huang JY. Cost-effectiveness analysis of malaria rapid diagnostic tests: a systematic review. Infect Dis Poverty 2019; 8:104. [PMID: 31888731 PMCID: PMC6937952 DOI: 10.1186/s40249-019-0615-8] [Citation(s) in RCA: 15] [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: 06/29/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDT) can effectively manage malaria cases and reduce excess costs brought by misdiagnosis. However, few studies have evaluated the economic value of this technology. The purpose of this study is to systematically review the economic value of RDT in malaria diagnosis. MAIN TEXT A detailed search strategy was developed to identify published economic evaluations that provide evidence regarding the cost-effectiveness of malaria RDT. Electronic databases including MEDLINE, EMBASE, Biosis Previews, Web of Science and Cochrane Library were searched from Jan 2007 to July 2018. Two researchers screened studies independently based on pre-specified inclusion and exclusion criteria. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was applied to evaluate the quality of the studies. Then cost and effectiveness data were extracted and summarized in a narrative way. Fifteen economic evaluations of RDT compared to other diagnostic methods were identified. The overall quality of studies varied greatly but most of them were scored to be of high or moderate quality. Ten of the fifteen studies reported that RDT was likely to be a cost-effective approach compared to its comparisons, but the results could be influenced by the alternatives, study perspectives, malaria prevalence, and the types of RDT. CONCLUSIONS Based on available evidence, RDT had the potential to be more cost-effective than either microscopy or presumptive diagnosis. Further research is also required to draw a more robust conclusion.
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Affiliation(s)
- Xiao-Xiao Ling
- School of Public Health, Fudan University, Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, 200032, China
| | - Jia-Jie Jin
- School of Public Health, Fudan University, Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, 200032, China
| | - Guo-Ding Zhu
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Public Health Research Centre, Jiangnan University, Wuxi, 214122, China
| | - Wei-Ming Wang
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Yuan-Yuan Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Meng-Meng Yang
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Hua-Yun Zhou
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Jun Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- Public Health Research Centre, Jiangnan University, Wuxi, 214122, China.
| | - Jia-Yan Huang
- School of Public Health, Fudan University, Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, 200032, China.
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Model-based economic evaluations of diagnostic point of care tests were rarely fit for purpose. J Clin Epidemiol 2018; 109:1-11. [PMID: 30423377 DOI: 10.1016/j.jclinepi.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/09/2018] [Accepted: 11/05/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Linked evidence models are recommended to predict health benefits and cost-effectiveness of diagnostic tests. We considered how published models accounted for changes in patient pathways that occur with point of care tests (POCTs) and their impact on patient health and costs. STUDY DESIGN AND SETTING Model-based evaluations of diagnostic POCTs published from 2004 to 2017 were identified from searching six databases. For each model, we assessed the outcomes considered, and whether reduced time to diagnosis and increased access to testing affected patient health and costs. RESULTS Seventy-four model-based evaluations were included: 95% incorporated evidence on test accuracy, but 34% only assessed intermediate outcomes such as rates of correct diagnosis. Of 54 models where POCTs reduced testing time, 39% addressed the economic and 37% addressed the health benefits of faster diagnosis. No model considered differences in access to tests. CONCLUSION Many models fail to capture the effects of POCTs in increasing access, advancing speed of diagnosis and treatment, and reducing anxiety and the associated costs. Many only consider the impact of testing from changes in accuracy. Ensuring models incorporate changes in patient pathways from faster and more accessible testing will lead to economic evaluations that better reflect the impact of POCTs.
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Moraz G, Garcez ADS, de Assis EM, dos Santos JP, Barcellos NT, Kroeff LR. [Cost-effectiveness in health in Brazil: a systematic review]. CIENCIA & SAUDE COLETIVA 2017; 20:3211-29. [PMID: 26465862 DOI: 10.1590/1413-812320152010.00962015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 05/30/2015] [Indexed: 12/13/2022] Open
Abstract
A systematic review was performed with the aim of describing the landscape and evolution of cost-effectiveness studies in health in Brazil. The search for articles on cost-effectiveness was performed in the main electronic health databases. The review identified 83 cost-effectiveness studies conducted nationwide. Between the years 1990-2005 there were few studies published on cost-effectiveness, though between 2006 and 2014 there was a significant increase in the number of publications. As for the themes and objectives of the studies, the chronic degenerative diseases and infectious/contagious diseases reflect the epidemiological diversity of Brazil. A predominance of studies on health intervention/treatment was identified. Thus, this review reveals a compatible Brazilian epidemiological reality scenario, indicating a need to increase research and investment of funds in the area of preventive health.
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Affiliation(s)
- Gabriele Moraz
- Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil,
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11
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Oliveira MRF, Leandro R, Decimoni TC, Rozman LM, Novaes HMD, De Soárez PC. Systematic Review of Health Economic Evaluations of Diagnostic Tests in Brazil: How accurate are the results? Clinics (Sao Paulo) 2017; 72:499-509. [PMID: 28954010 PMCID: PMC5577617 DOI: 10.6061/clinics/2017(08)08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/06/2017] [Indexed: 12/11/2022] Open
Abstract
The aim of this study is to identify and characterize the health economic evaluations (HEEs) of diagnostic tests conducted in Brazil, in terms of their adherence to international guidelines for reporting economic studies and specific questions in test accuracy reports. We systematically searched multiple databases, selecting partial and full HEEs of diagnostic tests, published between 1980 and 2013. Two independent reviewers screened articles for relevance and extracted the data. We performed a qualitative narrative synthesis. Forty-three articles were reviewed. The most frequently studied diagnostic tests were laboratory tests (37.2%) and imaging tests (32.6%). Most were non-invasive tests (51.2%) and were performed in the adult population (48.8%). The intended purposes of the technologies evaluated were mostly diagnostic (69.8%), but diagnosis and treatment and screening, diagnosis, and treatment accounted for 25.6% and 4.7%, respectively. Of the reviewed studies, 12.5% described the methods used to estimate the quantities of resources, 33.3% reported the discount rate applied, and 29.2% listed the type of sensitivity analysis performed. Among the 12 cost-effectiveness analyses, only two studies (17%) referred to the application of formal methods to check the quality of the accuracy studies that provided support for the economic model. The existing Brazilian literature on the HEEs of diagnostic tests exhibited reasonably good performance. However, the following points still require improvement: 1) the methods used to estimate resource quantities and unit costs, 2) the discount rate, 3) descriptions of sensitivity analysis methods, 4) reporting of conflicts of interest, 5) evaluations of the quality of the accuracy studies considered in the cost-effectiveness models, and 6) the incorporation of accuracy measures into sensitivity analyses.
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Affiliation(s)
- Maria Regina Fernandes Oliveira
- Faculdade de Medicina, Universidade de Brasilia, Campus Universitario Darcy Ribeiro, Brasilia, DF, BR
- Instituto de Avaliacao de Tecnologias em Saude (IATS/CNPq), Porto Alegre, RS, BR
| | - Roseli Leandro
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital de Transplantes Euryclides de Jesus Zerbini, Sao Paulo, SP, BR
| | - Tassia Cristina Decimoni
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luciana Martins Rozman
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Hillegonda Maria Dutilh Novaes
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Avaliacao de Tecnologias em Saude (IATS/CNPq), Porto Alegre, RS, BR
| | - Patrícia Coelho De Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Avaliacao de Tecnologias em Saude (IATS/CNPq), Porto Alegre, RS, BR
- *Corresponding author. E-mail:
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Rachid Viana GM, Akinyi Okoth S, Silva-Flannery L, Lima Barbosa DR, Macedo de Oliveira A, Goldman IF, Morton LC, Huber C, Anez A, Dantas Machado RL, Aranha Camargo LM, Costa Negreiros do Valle S, Marins Póvoa M, Udhayakumar V, Barnwell JW. Histidine-rich protein 2 (pfhrp2) and pfhrp3 gene deletions in Plasmodium falciparum isolates from select sites in Brazil and Bolivia. PLoS One 2017; 12:e0171150. [PMID: 28301474 PMCID: PMC5354239 DOI: 10.1371/journal.pone.0171150] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/16/2017] [Indexed: 11/18/2022] Open
Abstract
More than 80% of available malaria rapid diagnostic tests (RDTs) are based on the detection of histidine-rich protein-2 (PfHRP2) for diagnosis of Plasmodium falciparum malaria. Recent studies have shown the genes that code for this protein and its paralog, histidine-rich protein-3 (PfHRP3), are absent in parasites from the Peruvian Amazon Basin. Lack of PfHRP2 protein through deletion of the pfhrp2 gene leads to false-negative RDT results for P. falciparum. We have evaluated the extent of pfhrp2 and pfhrp3 gene deletions in a convenience sample of 198 isolates from six sites in three states across the Brazilian Amazon Basin (Acre, Rondonia and Para) and 25 isolates from two sites in Bolivia collected at different times between 2010 and 2012. Pfhrp2 and pfhrp3 gene and their flanking genes on chromosomes 7 and 13, respectively, were amplified from 198 blood specimens collected in Brazil. In Brazil, the isolates collected in Acre state, located in the western part of the Brazilian Amazon, had the highest percentage of deletions for pfhrp2 25 (31.2%) of 79, while among those collected in Rondonia, the prevalence of pfhrp2 gene deletion was only 3.3% (2 out of 60 patients). In isolates from Para state, all parasites were pfhrp2-positive. In contrast, we detected high proportions of isolates from all 3 states that were pfhrp3-negative ranging from 18.3% (11 out of 60 samples) to 50.9% (30 out of 59 samples). In Bolivia, only one of 25 samples (4%) tested had deleted pfhrp2 gene, while 68% (17 out of 25 samples) were pfhrp3-negative. Among the isolates tested, P. falciparum pfhrp2 gene deletions were present mainly in those from Acre State in the Brazilian Amazon. These results indicate it is important to reconsider the use of PfHRP2-based RDTs in the western region of the Brazilian Amazon and to implement appropriate surveillance systems to monitor pfhrp2 gene deletions in this and other parts of the Amazon region.
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Affiliation(s)
| | - Sheila Akinyi Okoth
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Atlanta Research and Education Foundation, Decatur, Georgia, United States of America
| | - Luciana Silva-Flannery
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Atlanta Research and Education Foundation, Decatur, Georgia, United States of America
| | | | - Alexandre Macedo de Oliveira
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ira F. Goldman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lindsay C. Morton
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Curtis Huber
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Arletta Anez
- Pan American Health Organization, La Paz, Bolivia
| | | | | | | | | | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - John W. Barnwell
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Bôtto-Menezes C, Bardají A, dos Santos Campos G, Fernandes S, Hanson K, Martínez-Espinosa FE, Menéndez C, Sicuri E. Costs Associated with Malaria in Pregnancy in the Brazilian Amazon, a Low Endemic Area Where Plasmodium vivax Predominates. PLoS Negl Trop Dis 2016; 10:e0004494. [PMID: 27031515 PMCID: PMC4816546 DOI: 10.1371/journal.pntd.0004494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/06/2016] [Indexed: 11/30/2022] Open
Abstract
Background Information on costs associated with malaria in pregnancy (MiP) in low transmission areas where Plasmodium vivax predominates is so far missing. This study estimates health system and patient costs of MiP in the Brazilian Amazon. Methods/Principal Findings Between January 2011 and March 2012 patient costs for the treatment of MiP were collected through an exit survey at a tertiary referral hospital and at a primary health care centre in the Manaus metropolitan area, Amazonas state. Pregnant and post-partum women diagnosed with malaria were interviewed after an outpatient consultation or at discharge after admission. Seventy-three interviews were included in the analysis. Ninety-six percent of episodes were due to P. vivax and 4% to Plasmodium falciparum. In 2010, the total median costs from the patient perspective were estimated at US $45.91 and US $216.29 for an outpatient consultation and an admission, respectively. When multiple P. vivax infections during the same pregnancy were considered, patient costs increased up to US $335.85, representing the costs of an admission plus an outpatient consultation. Provider direct and overhead cost data were obtained from several sources. The provider cost associated with an outpatient case, which includes several consultations at the tertiary hospital was US $103.51 for a P. vivax malaria episode and US $83.59 for a P. falciparum malaria episode. The cost of an inpatient day and average admission of 3 days was US $118.51 and US $355.53, respectively. Total provider costs for the diagnosis and treatment of all malaria cases reported in pregnant women in Manaus in 2010 (N = 364) were US $17,038.50, of which 92.4% (US$ 15,741.14) due to P. vivax infection. Conclusion Despite being an area of low risk malaria transmission, MiP is responsible for a significant economic burden in Manaus. Especially when multiple infections are considered, costs associated with P. vivax are higher than costs associated with P. falciparum. The information generated may help health policy decisions for the current control and future elimination of malaria in the area. Malaria in pregnancy (MiP) is associated with maternal and foetal morbidity and mortality. In addition to the clinical burden, MiP implies a significant economic burden, but the little available evidence on the economics of MiP is limited to Plasmodium falciparum malaria and to the sub-Saharan region. While an increasing interest has been recently devoted to the epidemiology and the clinical consequences of Plasmodium vivax, the economics of P. vivax malaria is neglected. P. vivax is endemic in Latin America, and Brazil is the country with the highest reported burden of MiP of the American continent. Between 2011 and 2012, we conducted a study in the city of Manaus, Brazilian Amazon, with the aim of estimating costs associated with MiP both from the health provider and the patient perspectives. Despite being an area of low transmission risk, we found that the costs of treating MiP are not negligible. In particular, both from the patient and the provider perspectives, costs underwent a remarkable increase when admission was required and when the cost of subsequent P. vivax malaria episodes during the same pregnancy occurred. The information generated may help health policy decisions for the current control and future elimination of malaria in the area.
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Affiliation(s)
- Camila Bôtto-Menezes
- Universidade do Estado do Amazonas (UEA), Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- * E-mail:
| | - Azucena Bardají
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Giselane dos Santos Campos
- Núcleo de Estudos e Pesquisas das Cidades na Amazônia Brasileira da Universidade Federal do Amazonas (NEPECAB/UFAM), Manaus, Amazonas, Brazil
- Faculdade Metropolitana de Manaus (FAMETRO), Manaus, Amazonas, Brazil
| | - Silke Fernandes
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Flor Ernestina Martínez-Espinosa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Centro de Pesquisa Leônidas e Maria Deane/Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
| | - Clara Menéndez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Elisa Sicuri
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
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14
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Peixoto HM, Brito MAM, Romero GAS, Monteiro WM, de Lacerda MVG, de Oliveira MRF. Cost-effectiveness analysis of rapid diagnostic tests for G6PD deficiency in patients with Plasmodium vivax malaria in the Brazilian Amazon. Malar J 2016; 15:82. [PMID: 26864333 PMCID: PMC4750282 DOI: 10.1186/s12936-016-1140-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 02/02/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The use of primaquine (PQ) for radical treatment of Plasmodium vivax in carriers of G6PD deficiency (G6PDd) constitutes the main factor associated with severe haemolysis in G6PDd. The current study aimed to estimate the incremental cost-effectiveness ratio of using a rapid diagnostic test (RDT) to detect G6PDd in male patients with P. vivax malaria in the Brazilian Amazon, in comparison with the routine indicated by the Programme for Malaria Control, which does not include this evaluation. METHODS A cost-effectiveness analysis of estimated RDT use was carried out for the Brazilian Amazon for the year 2013, considering the perspective of the Brazilian Public Health System. Using decision trees, estimates were compared for two different RDT strategies for G6PDd in male individuals infected with P. vivax before being prescribed PQ, with the routine indicated in Brazil, which does not include prior diagnosis of G6PDd. The first strategy considered the combined use of RDT BinaxNOW(®) G6PD (BX-G6PD) in municipalities with more than 100,000 inhabitants and the routine programme (RP) for the other municipalities. Operational limitations related to the required temperature control and venous blood collection currently restrict the use of RDT BX-G6PD in small municipalities. The second strategy considered the use of the RDT CareStart™ G6PD (CS-G6PD) in 100 % of the municipalities. The analysis was carried out for the outcomes: "adequately diagnosed case" and "hospitalization avoided". RESULTS For the outcome "adequately diagnosed case", comparing the RDT strategies based on RDT with the routine control programme (RP), the CS-G6PD strategy was the most cost-effective, with BX-G6PD extendedly dominating (the ICER of BX-G6PD compared with RP was higher than the ICER of CS-G6PD compared with RP). CS-G6PD dominated the other strategies for the "hospitalization avoided" outcome. CONCLUSION The CS-G6PD strategy is cost-effective for adequately diagnosing cases and avoiding hospitalization. This information can help in decision-making, both in incorporating prior diagnosis in the use of PQ and to promote greater safety among G6PD deficient individuals in the Brazilian Amazon P. vivax endemic areas.
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Affiliation(s)
- Henry M Peixoto
- Center for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil. .,University Centre of Brasília, Brasília, Federal District, Brazil. .,National Institute for Science and Technology for Health Technology Assessment (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marcelo A M Brito
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil. .,University of the State of Amazonas, Manaus, Amazonas, Brazil.
| | - Gustavo A S Romero
- Center for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil. .,National Institute for Science and Technology for Health Technology Assessment (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Wuelton M Monteiro
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil. .,University of the State of Amazonas, Manaus, Amazonas, Brazil.
| | - Marcus V G de Lacerda
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil. .,Instituto Leônidas e Maria Deane, FIOCRUZ, Manaus, Amazonas, Brazil.
| | - Maria R F de Oliveira
- Center for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil. .,National Institute for Science and Technology for Health Technology Assessment (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil.
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15
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Vassall A, Mangham‐Jefferies L, Gomez GB, Pitt C, Foster N. Incorporating Demand and Supply Constraints into Economic Evaluations in Low-Income and Middle-Income Countries. HEALTH ECONOMICS 2016; 25 Suppl 1:95-115. [PMID: 26786617 PMCID: PMC5042074 DOI: 10.1002/hec.3306] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Global guidelines for new technologies are based on cost and efficacy data from a limited number of trial locations. Country-level decision makers need to consider whether cost-effectiveness analysis used to inform global guidelines are sufficient for their situation or whether to use models that adjust cost-effectiveness results taking into account setting-specific epidemiological and cost heterogeneity. However, demand and supply constraints will also impact cost-effectiveness by influencing the standard of care and the use and implementation of any new technology. These constraints may also vary substantially by setting. We present two case studies of economic evaluations of the introduction of new diagnostics for malaria and tuberculosis control. These case studies are used to analyse how the scope of economic evaluations of each technology expanded to account for and then address demand and supply constraints over time. We use these case studies to inform a conceptual framework that can be used to explore the characteristics of intervention complexity and the influence of demand and supply constraints. Finally, we describe a number of feasible steps that researchers who wish to apply our framework in cost-effectiveness analyses.
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Affiliation(s)
- Anna Vassall
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Gabriela B. Gomez
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
- Department of Global Health, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Institute for Global Health and DevelopmentAmsterdamThe Netherlands
| | - Catherine Pitt
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Nicola Foster
- Health Economics Unit, School of Public Health and Family MedicineUniversity of Cape TownSouth Africa
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16
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Peixoto HM, Brito MAM, Romero GAS, Monteiro WM, de Lacerda MVG, de Oliveira MRF. G6PD deficiency in male individuals infected by Plasmodium vivax malaria in the Brazilian Amazon: a cost study. Malar J 2015; 14:126. [PMID: 25889063 PMCID: PMC4381355 DOI: 10.1186/s12936-015-0647-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/10/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Deficiency of the enzyme G6PD (G6PDd) is caused by mutations in the gene G6PD, which plays an important role in protecting the red blood cell against oxidizing agents; it is linked to chromosome X, and it may affects both sexes. The clinically relevant manifestations, such as acute haemolytic anaemia, mainly occur in men, however. The 8-aminoquinoline primaquine, which is the medication used in the radical treatment of malaria caused by Plasmodium vivax, represents the main factor that triggers complications associated with G6PDd. The current study aims to estimate the costs of G6PDd among male individuals infected by P. vivax in the Brazilian Amazon. METHODS This is an economic analysis developed within the Brazilian National Health System perspective for the years of 2009, 2010 and 2011. Direct medical and non-medical costs were estimated for G6PDd in the Brazilian Amazon, considering among those suffering from the deficiency the costs of diagnosing infection by P. vivax, its treatment and severe adverse events that require hospitalization and were connected to the use of primaquine. RESULTS The estimates of the average costs of diagnosing vivax malaria, of its treatment and of severe adverse events after using primaquine among the carriers of G6PDd, over the three evaluated years, corresponded to US$ 739,410.42; US$ 2,120.04 and US$ 4,858,108.87, respectively. The results indicate that the average total cost in the study period corresponded to US$ 5,599,639.33, varying in accordance with the sensitivity analysis between US$ 4,439,512.14 and US$ 6,702,619.24. CONCLUSION The results indicate that the use of primaquine among men with G6PDd who are infected by P. vivax represents a heavy burden on the public health service of Brazil.
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Affiliation(s)
- Henry M Peixoto
- Centre for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil.
- University Centre of Brasília, Brasília, Federal District, Brazil.
| | - Marcelo A M Brito
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
- University of the State of Amazonas, Manaus, Amazonas, Brazil.
| | - Gustavo A S Romero
- Centre for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil.
- National Institute for Science and Technology for Health Technology Assessment (IATS/CNPq), Porto Alegre, RS, Brazil.
| | - Wuelton M Monteiro
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
- University of the State of Amazonas, Manaus, Amazonas, Brazil.
| | - Marcus V G de Lacerda
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
- University of the State of Amazonas, Manaus, Amazonas, Brazil.
- Centro de Pesquisas Leônidas & Maria Deane, FIOCRUZ, Manaus, Amazonas, Brazil.
| | - Maria Regina F de Oliveira
- Centre for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil.
- National Institute for Science and Technology for Health Technology Assessment (IATS/CNPq), Porto Alegre, RS, Brazil.
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17
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Hasselback L, Crawford J, Chaluco T, Rajagopal S, Prosser W, Watson N. Rapid diagnostic test supply chain and consumption study in Cabo Delgado, Mozambique: estimating stock shortages and identifying drivers of stock-outs. Malar J 2014; 13:295. [PMID: 25086645 PMCID: PMC4237853 DOI: 10.1186/1475-2875-13-295] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/28/2014] [Indexed: 11/18/2022] Open
Abstract
Background Malaria rapid diagnostic tests (RDTs) are particularly useful in low-resource settings where follow-through on traditional laboratory diagnosis is challenging or lacking. The availability of these tests depends on supply chain processes within the distribution system. In Mozambique, stock-outs of malaria RDTs are fairly common at health facilities. A longitudinal cross-sectional study was conducted to evaluate drivers of stock shortages in the Cabo Delgado province. Methods Data were collected from purposively sampled health facilities, using monthly cross-sectional surveys between October 2011 and May 2012. Estimates of lost consumption (consumption not met due to stock-outs) served as the primary quantitative indicator of stock shortages. This is a better measure of the magnitude of stock-outs than binary indicators that only measure frequency of stock-outs at a given facility. Using a case study based methodology, distribution system characteristics were qualitatively analysed to examine causes of stock-outs at the provincial, district and health centre levels. Results 15 health facilities were surveyed over 120 time points. Stock-out patterns varied by data source; average monthly proportions of 59%, 17% and 17% of health centres reported a stock-out on stock cards, laboratory and pharmacy forms, respectively. Estimates of lost consumption percentage were significantly high; ranging from 0% to 149%; with a weighted average of 78%. Each ten-unit increase in monthly-observed consumption was associated with a nine-unit increase in lost consumption percentage indicating that higher rates of stock-outs occurred at higher levels of observed consumption. Causes of stock-outs included inaccurate tracking of lost consumption, insufficient sophistication in inventory management and replenishment, and poor process compliance by facility workers, all arguably stemming from inadequate attention to the design and implementation of the distribution system. Conclusions Substantially high levels of RDT stock-outs were found in Cabo Delgado. Study findings point to a supply chain with a commendable degree of sophistication. However, insufficient attention paid to system design and implementation resulted in deteriorating performance in areas of increased need. In such settings fast moving commodities like malaria RDTs can call attention to supply chain vulnerabilities, the findings from which can be used to address other slower moving health commodities.
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Affiliation(s)
| | | | | | | | | | - Noel Watson
- OPS MEND, 43 Riverside Ave, Suite 103, Medford, MA 02155, USA.
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18
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Sousa LP, Mariuba LAM, Holanda RJ, Pimentel JP, Almeida MEM, Chaves YO, Borges D, Lima E, Crainey JL, Orlandi PP, Lacerda MV, Nogueira PA. A novel polyclonal antibody-based sandwich ELISA for detection of Plasmodium vivax developed from two lactate dehydrogenase protein segments. BMC Infect Dis 2014; 14:49. [PMID: 24475751 PMCID: PMC3913629 DOI: 10.1186/1471-2334-14-49] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immunoassays for Plasmodium detection are, presently, most frequently based on monoclonal antibodies (MAbs); Polyclonal antibodies (PAbs), which are cheaper to develop and manufacture, are much less frequently used. In the present study we describe a sandwich ELISA assay which is capable of detecting P. vivax Lactate Dehydrogenase (LDH) in clinical blood samples, without cross reacting with those infected with P. falciparum. METHODS Two recombinant proteins were produced from different regions of the P. vivax LDH gene. Two sandwich ELISA assay were then designed: One which uses mouse anti-LDH 1-43aa PAbs as primary antibodies ("Test 1") and another which uses anti-LDH 35-305aa PAbs ("Test 2") as the primary antibodies. Rabbit anti-LDH 1-43aa PAbs were used as capture antibodies in both ELISA assays. Blood samples taken from P. vivax and P. falciparum infected patients (confirmed by light microscopy) were analysed using both tests. RESULTS "Test 2" performed better at detecting microscopy-positive blood samples when compared to "Test 1", identifying 131 of 154 positive samples (85%); 85 positives (55%) were identified using "test 1". "Test 1" produced one false positive sample (from the 20 malaria-free control) blood samples; "test 2" produced none. Kappa coefficient analysis of the results produced a value of 0.267 when microscope-positive blood smears were compared with "test 1", but 0.734 when microscope-positive blood smears were compared with the results from "test 2". Positive predictive value (PPV) and negative predictive value (NPV) were observed to be 98% and 22% respectively, for "Test 1", and 99% and 45%, for "test 2". No cross reactivity was detected with P. falciparum positive blood samples (n = 15) with either test assay. CONCLUSION Both tests detected P. vivax infected blood and showed no evidence of cross-reacting with P. falciparum. Further studies will need to be conducted to establish the full potential of this technique for malaria diagnostics. As well as representing a promising new cost-effective novel technique for P. vivax diagnosis and research, the method for developing this assay also highlights the potential for PAb-based strategies for diagnostics in general.
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