1
|
Muniyandi M, Karikalan N, Ravi K, Sengodan S, Krishnan R, Tyagi K, Rajsekar K, Raju S, Selvavinayagam TS. An economic evaluation of implementing a decentralized dengue screening intervention under the National Vector Borne Disease Control Programme in Tamil Nadu, South India. Int Health 2021; 14:295-308. [PMID: 34453836 PMCID: PMC9070504 DOI: 10.1093/inthealth/ihab045] [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: 05/08/2021] [Revised: 06/29/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background Lack of effective early screening is a major obstacle for reducing the fatality rate and disease burden of dengue. In light of this, the government of Tamil Nadu has adopted a decentralized dengue screening strategy at the primary healthcare (PHC) facilities using blood platelet count. Our objective was to determine the cost-effectiveness of a decentralized screening strategy for dengue at PHC facilities compared with the current strategy at the tertiary health facility (THC) level. Methods Decision tree analysis followed a hypothetical cohort of 1000 suspected dengue cases entering the model. The cost-effectiveness analysis was performed at a 3% discount rate for the proposed and current strategy. The outcomes are expressed in incremental cost-effectiveness ratios (ICERs) per quality-adjusted life years gained. One-way sensitivity analysis and probabilistic sensitivity analysis were done to check the uncertainty in the outcome. Results The proposed strategy was found to be cost-saving and ICER was estimated to be −41 197. PSA showed that the proposed strategy had a 0.84 probability of being an economically dominant strategy. Conclusions The proposed strategy is cost-saving, however, it is recommended to consider optimal population coverage, costs to economic human resources and collateral benefits of equipment.
Collapse
Affiliation(s)
- Malaisamy Muniyandi
- Scientist-D & Head, Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, No. 1, Sathyamoorthy Road, Chetpet, Chennai 60003, India
| | - Nagarajan Karikalan
- Scientist-D & Head, Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, No. 1, Sathyamoorthy Road, Chetpet, Chennai 60003, India
| | - Karunya Ravi
- Scientist-D & Head, Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, No. 1, Sathyamoorthy Road, Chetpet, Chennai 60003, India
| | - Senthilkumar Sengodan
- Scientist-D & Head, Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, No. 1, Sathyamoorthy Road, Chetpet, Chennai 60003, India
| | - Rajendran Krishnan
- Scientist-D & Head, Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, No. 1, Sathyamoorthy Road, Chetpet, Chennai 60003, India
| | - Kirti Tyagi
- Department of Health Research, Ministry of Health and Family Welfare, 2nd Floor, IRCS Building, 1, Red Cross Road, New Delhi 110001, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, 2nd Floor, IRCS Building, 1, Red Cross Road, New Delhi 110001, India
| | - Sivadhas Raju
- Department of Public Health and Preventive Medicine, Government of Tamil Nadu, 359, Anna Salai, Chokkalingam Nagar, Teynampet, Chennai 600006, India
| | - T S Selvavinayagam
- Department of Public Health and Preventive Medicine, Government of Tamil Nadu, 359, Anna Salai, Chokkalingam Nagar, Teynampet, Chennai 600006, India
| |
Collapse
|
2
|
Huang Y, Williamson BD, Moodie Z, Carpp LN, Chambonneau L, DiazGranados CA, Gilbert PB. Analysis of Neutralizing Antibodies as a Correlate of Instantaneous Risk of Hospitalized Dengue in Placebo Recipients of Dengue Vaccine Efficacy Trials. J Infect Dis 2021; 225:332-340. [PMID: 34174082 DOI: 10.1093/infdis/jiab342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the CYD14 (NCT01373281) and CYD15 (NCT01374516) dengue vaccine efficacy trials, Month 13 neutralizing antibody (nAb) titers correlated inversely with risk of symptomatic, virologically confirmed dengue (VCD) between Month 13 (one month post-final-dose) and Month 25. We assessed nAb titer as a correlate of instantaneous risk of hospitalized VCD (HVCD), for which participants were continually surveilled for 72 months. METHODS Using longitudinal nAb titers from the per-protocol immunogenicity subsets, we estimated hazard ratios (HRs) of HVCD by current nAb titer value for three correlate/endpoint pairs: average titer across all four serotypes/HVCD of any serotype (HVCD-Any), serotype-specific titer/homologous HVCD, and serotype-specific titer/heterologous HVCD. RESULTS Baseline-seropositive placebo recipients with higher average titer had lower instantaneous risk of HVCD-Any in 2-16-year-olds and in 9-16-year-olds (HR 0.26 or 0.15 per 10-fold increase in average titer by two methods, 95% CIs 0.14 to 0.45 and 0.07 to 0.34, respectively) pooled across both trials. Results were similar for homologous HVCD. There was evidence suggesting increased HVCD-Any risk in participants with low average titer (1:10 to 1:100) compared to seronegative participants (HR 1.85, 95% CI 0.93 to 3.68). CONCLUSIONS Natural infection-induced nAbs were inversely associated with hospitalized dengue, upon exceeding a relatively low threshold.
Collapse
Affiliation(s)
- Ying Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, 98109, United States of America.,Department of Biostatistics, University of Washington, Seattle, 98109, United States of America
| | - Brian D Williamson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, 98109, United States of America
| | - Zoe Moodie
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, 98109, United States of America
| | - Lindsay N Carpp
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, 98109, United States of America
| | | | - Carlos A DiazGranados
- Clinical Sciences, Sanofi Pasteur, Swiftwater, Pennsylvania, United States of America
| | - Peter B Gilbert
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, 98109, United States of America.,Department of Biostatistics, University of Washington, Seattle, 98109, United States of America
| |
Collapse
|
3
|
Wilastonegoro NN, Kharisma DD, Laksono IS, Halasa-Rappel YA, Brady OJ, Shepard DS. Cost of Dengue Illness in Indonesia across Hospital, Ambulatory, and not Medically Attended Settings. Am J Trop Med Hyg 2021; 103:2029-2039. [PMID: 32901596 PMCID: PMC7646801 DOI: 10.4269/ajtmh.19-0855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Informed decisions concerning emerging technologies against dengue require knowledge about the disease’s economic cost and each stakeholder’s potential benefits from better control. To generate such data for Indonesia, we reviewed recent literature, analyzed expenditure and utilization data from two hospitals and two primary care facilities in Yogyakarta city, and interviewed 67 dengue patients from hospital, ambulatory, and not medically attended settings. We derived the cost of a dengue episode by outcome, setting, and the breakdown by payer. We then calculated aggregate Yogyakarta and national costs and 95% uncertainty intervals (95% UIs). Dengue costs per nonfatal case in hospital, ambulatory, not medically attended, and overall average settings were US$316.24 (95% UI: $242.30–$390.18), US$22.45 (95% UI: $14.12–$30.77), US$7.48 (95% UI: $2.36–$12.60), and US$50.41 (95% UI: $35.75–$65.07), respectively. Costs of nonfatal episodes were borne by the patient’s household (37%), social contributors (relatives and friends, 20%), national health insurance (25%), and other sources (government, charity, and private insurance, 18%). After including fatal cases, the average cost per episode became $90.41 (95% UI: $72.79–$112.35). Indonesia had an estimated 7.535 (95% UI: 1.319–16.513) million dengue episodes in 2017, giving national aggregate costs of $681.26 (95% UI: $232.28–$2,371.56) million. Unlike most previous research that examined only the formal medical sector, this study included the estimated 63% of national dengue episodes that were not medically attended. Also, this study used actual costs, rather than charges, which generally understate dengue’s economic burden in public facilities. Overall, this study found that Indonesia’s aggregate cost of dengue was 73% higher than previously estimated, strengthening the need for effective control.
Collapse
Affiliation(s)
- Nandyan N Wilastonegoro
- Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Dinar D Kharisma
- Heller School for Social Management and Policy, Brandeis University, Waltham, Massachusetts
| | - Ida S Laksono
- Pediatrics Department, Faculty of Medicine, Public Health and Nursing, Dr. Sardjito General Hospital, Gadjah Mada University, Yogyakarta, Indonesia
| | - Yara A Halasa-Rappel
- Heller School for Social Management and Policy, Brandeis University, Waltham, Massachusetts
| | - Oliver J Brady
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Donald S Shepard
- Heller School for Social Management and Policy, Brandeis University, Waltham, Massachusetts
| |
Collapse
|
4
|
da Silva Ferreira ER, de Oliveira Gonçalves AC, Tobal Verro A, Undurraga EA, Lacerda Nogueira M, Estofolete CF, Santos da Silva N. Evaluating the validity of dengue clinical-epidemiological criteria for diagnosis in patients residing in a Brazilian endemic area. Trans R Soc Trop Med Hyg 2020; 114:603-611. [PMID: 32497201 DOI: 10.1093/trstmh/traa031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/15/2020] [Accepted: 04/23/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We evaluated the validity of clinical diagnosis compared with laboratory diagnosis of dengue in a retrospective sample of patients in São José do Rio Preto, Brazil. METHODS Our sample included 148 299 clinically (56.3%) or laboratory-diagnosed (43.7%) dengue cases. We compared the sensitivity, specificity, positive and negative predictive value (PPV and NPV) of dengue patients' demographic and clinical characteristics with laboratory-based diagnosis. We used logistic regressions to estimate the correlation between clinical and laboratory diagnosis of dengue and a full set of dengue signs and symptoms. RESULTS We found substantial variability in sensitivity and specificity of signs and symptoms ranging from 0.8-81.1 and 21.5-99.6, respectively. Thrombocytopenia exhibited the highest PPV (92.0) and lowest NPV (42.2) and was the only symptom showing agreement with laboratory-confirmed dengue (φ = 0.38). The presence of exanthema and thrombocytopenia led to a greater likelihood of concordant clinical and laboratory diagnoses (exanthema: OR: 4.23; 95% CI: 2.09 to 8.57; thrombocytopenia: OR: 4.02; 95% CI: 1.32 to 12.27). CONCLUSIONS We found substantial variation in sensitivity, specificity, PPV and NPV of dengue signs and symptoms. For accuracy, clinical and laboratory diagnosis of dengue should be performed concurrently. When laboratory tests are not available, we suggest focusing on the clinical manifestations most associated with dengue.
Collapse
Affiliation(s)
- Elis Regina da Silva Ferreira
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina de São José do Rio Preto, Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto - São Paulo, CEP 15090-000, Brazil
| | | | - Alice Tobal Verro
- Faculdade de Medicina, União das Faculdades dos Grandes Lagos, São José do Rio Preto, São Paulo, 15030-070, Brazil
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, 13083-872, Chile
| | - Maurício Lacerda Nogueira
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto, São Paulo, 15090-000, Brazil
| | - Cássia Fernanda Estofolete
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto, São Paulo, 15090-000, Brazil
| | - Natal Santos da Silva
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina de São José do Rio Preto, Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto - São Paulo, CEP 15090-000, Brazil
| |
Collapse
|