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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: 26] [Impact Index Per Article: 8.7] [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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Moukoumbi Lipenguet G, Ngoungou EB, Ibinga E, Engohang-Ndong J, Wittwer J. Evaluation of direct costs associated with the management of clinical stage of malaria in children under five years old in Gabon. Malar J 2021; 20:334. [PMID: 34330288 PMCID: PMC8325277 DOI: 10.1186/s12936-021-03862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is one of the leading causes of morbidity and mortality in African countries. It is one of the leading causes of hospital visits and hospitalization in pediatric wards for children under 5 years old. Interestingly however, the economic burden of this disease remains unknown in these endemic countries including Gabon. The purpose of this study is to assess the direct hospital cost for the management of malaria in children under 5 years old at the Libreville University Hospital Centre (CHUL, Centre Hospitalier Universitaire de Libreville) in Gabon. METHODS This research work is a retrospective study using a comprehensive review of medical records of patients seen at the CHUL over a two-year period extending from January 2018 through December 2019. The study focused on children under 5 years old, admitted for malaria in the paediatric ward of the CHUL. The analysis targeted specifically direct hospital costs, which excluded salary and wages of health care workers. The monetary currency used in this study was the CFA francs, as that currency is the one used in Central Africa (as reference, 1 Euro = 656 CFA francs). RESULTS For the set timeframe, 778 patient records matched the study criteria. Thus, out of 778 admitted patients, 58.4% were male while 41.5% were female. Overall, the average age was 13.2 months (± 13.8 months). The total cost incurred by the hospital for the management of these 778 malaria patients was 94,922,925 CFA francs (144,699.58 €), for an average expense per patient topping at 122,008 CFA francs (185.99 €). The highest expenditure items were hospitalizations (44,200,000 CFA francs, 67,378.1 €), followed by drugs (26,394,425 CFA francs, 40,235.4 €) and biomedical examinations (14,036,000 CFA francs, 21,396.34 €). CONCLUSION The financial burden for managing malaria in the paediatric ward seems to be very high, not only for the hospital, but also for families in spite of the government medical insurance coverage in some cases. These findings bring new insights as to the urgency to develop policies that foster preventive initiatives over curative approaches in the management of malaria in children in endemic countries.
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Affiliation(s)
- Gaëtan Moukoumbi Lipenguet
- University of Bordeaux, Population Health of Bordeaux, Inserm U1219, EMOS team. ISPED, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France. .,Department of Epidemiology-Biostatistics and Medical Informatics (DEBIM), Faculty of Medicine, University of Health Sciences, BP: 4009, Libreville, Gabon. .,University of Health Sciences, Research Unit in Epidemiology of Chronic Diseases and Environmental Health (UREMCSE), BP: 11587, Libreville, Gabon.
| | - Edgard Brice Ngoungou
- Department of Epidemiology-Biostatistics and Medical Informatics (DEBIM), Faculty of Medicine, University of Health Sciences, BP: 4009, Libreville, Gabon.,University of Health Sciences, Research Unit in Epidemiology of Chronic Diseases and Environmental Health (UREMCSE), BP: 11587, Libreville, Gabon.,UMR 1094 Inserm partner IRD-Tropical Neuroepidemiology (NET), Faculty of Medicine of the University of Limoges, 87 025, Limoges, France
| | - Euloge Ibinga
- Department of Epidemiology-Biostatistics and Medical Informatics (DEBIM), Faculty of Medicine, University of Health Sciences, BP: 4009, Libreville, Gabon.,University of Health Sciences, Research Unit in Epidemiology of Chronic Diseases and Environmental Health (UREMCSE), BP: 11587, Libreville, Gabon
| | - Jean Engohang-Ndong
- Department of Epidemiology-Biostatistics and Medical Informatics (DEBIM), Faculty of Medicine, University of Health Sciences, BP: 4009, Libreville, Gabon.,University of Health Sciences, Research Unit in Epidemiology of Chronic Diseases and Environmental Health (UREMCSE), BP: 11587, Libreville, Gabon.,Department of Biological Sciences, Kent State University at Tuscarawas, 330 University Dr. NE, New Philadelphia, OH, 44663, USA
| | - Jérôme Wittwer
- University of Bordeaux, Population Health of Bordeaux, Inserm U1219, EMOS team. ISPED, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France
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Traore O, Ouedraogo A, Compaore M, Nikiema K, Zombre A, Kiendrebeogo M, Blankert B, Duez P. Social perceptions of malaria and diagnostic-driven malaria treatment in Burkina Faso. Heliyon 2021; 7:e05553. [PMID: 33458436 PMCID: PMC7797373 DOI: 10.1016/j.heliyon.2020.e05553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/01/2020] [Accepted: 11/16/2020] [Indexed: 11/09/2022] Open
Abstract
Malaria is a parasitic disease, endemic in many tropical and sub-tropical countries. Malaria is a well-known disease, familiar to almost all people in endemic regions, as they or their family are regularly confronted with it; everyone in these regions has probably experienced the disease, at least once in their life. To investigate the social perceptions of malaria in Burkina Faso, including its diagnosis-driven treatment, we have conducted a survey in both urban (Saint Camille Hospital, Ouagadougou HOSCO) and rural (Boussé Hospital) areas. Fifty-six individuals, mostly representatives of the society variability, were surveyed by questionnaires and 2 focus groups were organized with traditional healers. In general, populations seem to have grasped the causes, symptoms and means of preventing the disease. However, the majority of interviewees make a marked confusion between malaria and dengue; dengue fever is considered like a severe form of malaria. The care modalities (modern and/or traditional medicine) are plural and the choice of therapeutic practice depends on both the socio-economic conditions and education level of the patient. Whereas some patients mark preferences for one type of medicine, others simultaneously recourse to both; for these, a medicine does not outperform the other and their combination multiplies the chances of a quick recovery. Whether for modern or traditional medicine, the diagnosis is considered very important for effective disease management. Modern medicine uses diagnostic tools based on light microscopy and immunochromatography (rapid diagnostic tests; RDT); traditional medicine has its own diagnostic logic but nevertheless recognizes modern medicine diagnosis to guide its therapy. 90 % of those interviewed first use modern medicine to seek an accurate diagnosis of their disease and thus to receive adequate treatment. Presumptive treatments are still widely prescribed and accepted by most patients who trust the judgment of their caregiver, not perceiving any benefit to an objective diagnosis. In front of a negative diagnosis, patient reactions are diverse, some accepting investigations for other diseases (45 %), others opting for self-medication (15 %), others resorting to traditional medicine (20 %). All are unanimous in the importance of diagnosis and are in favor of in-development diagnostic technologies, provided these obviously meet the features of reliability, ease of use, availability and, of course, economical accessibility.
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Affiliation(s)
- Orokia Traore
- Laboratory of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons, Place du Parc 20, 7000 Mons, Belgium.,Laboratory of Pharmaceutical Analysis, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons, Place du Parc 20, 7000 Mons, Belgium.,Laboratoire de Biochimie et Chimie Appliquées (Université de Ouagadougou, Burkina Faso), Boulevard Charles de Gaule, 03 BP 7021 03, Ouagadougou 03, Burkina Faso
| | - Awa Ouedraogo
- Département d'Anthropologie, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso, Village de Nasso, 01 BP 1091, Bobo-dioulasso 01, Burkina Faso
| | - Moussa Compaore
- Laboratory of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons, Place du Parc 20, 7000 Mons, Belgium
| | - Kader Nikiema
- Département d'Anthropologie, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso, Village de Nasso, 01 BP 1091, Bobo-dioulasso 01, Burkina Faso
| | - Abdoulaye Zombre
- Département d'Anthropologie, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso, Village de Nasso, 01 BP 1091, Bobo-dioulasso 01, Burkina Faso
| | - Martin Kiendrebeogo
- Laboratoire de Biochimie et Chimie Appliquées (Université de Ouagadougou, Burkina Faso), Boulevard Charles de Gaule, 03 BP 7021 03, Ouagadougou 03, Burkina Faso
| | - Bertrand Blankert
- Laboratory of Pharmaceutical Analysis, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons, Place du Parc 20, 7000 Mons, Belgium
| | - Pierre Duez
- Laboratory of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons, Place du Parc 20, 7000 Mons, Belgium
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Traore O, Compaore M, Okusa P, Hubinon F, Duez P, Blankert B, Kindrebeogo M. Development and validation of an original magneto-chromatography device for the whole blood determination of hemozoin, the paramagnetic malaria pigment. Microchem J 2020. [DOI: 10.1016/j.microc.2020.105043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Osorio L, Garcia JA, Parra LG, Garcia V, Torres L, Degroote S, Ridde V. A scoping review on the field validation and implementation of rapid diagnostic tests for vector-borne and other infectious diseases of poverty in urban areas. Infect Dis Poverty 2018; 7:87. [PMID: 30173662 PMCID: PMC6120097 DOI: 10.1186/s40249-018-0474-8] [Citation(s) in RCA: 18] [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: 02/09/2018] [Accepted: 08/01/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings. There is a need to know what rapid diagnostic technologies are available, have been properly assessed, and are being implemented to improve control of these diseases in the urban context. This paper characterizes evidence on the field validation and implementation in urban areas of rapid diagnostics for vector-borne diseases and other diseases of poverty. MAIN BODY A scoping review was conducted. Peer-reviewed and grey literature were searched using terms describing the targeted infectious diseases, diagnostics evaluations, rapid tests, and urban setting. The review was limited to studies published between 2000 and 2016 in English, Spanish, French, and Portuguese. Inclusion and exclusion criteria were refined post hoc to identify relevant literature regardless of study design and geography. A total of 179 documents of the 7806 initially screened were included in the analysis. Malaria (n = 100) and tuberculosis (n = 47) accounted for the majority of studies that reported diagnostics performance, impact, and implementation outcomes. Fewer studies, assessing mainly performance, were identified for visceral leishmaniasis (n = 9), filariasis and leptospirosis (each n = 5), enteric fever and schistosomiasis (each n = 3), dengue and leprosy (each n = 2), and Chagas disease, human African trypanosomiasis, and cholera (each n = 1). Reported sensitivity of rapid tests was variable depending on several factors. Overall, specificities were high (> 80%), except for schistosomiasis and cholera. Impact and implementation outcomes, mainly acceptability and cost, followed by adoption, feasibility, and sustainability of rapid tests are being evaluated in the field. Challenges to implementing rapid tests range from cultural to technical and administrative issues. CONCLUSIONS Rapid diagnostic tests for vector-borne and other diseases of poverty are being used in the urban context with demonstrated impact on case detection. However, most evidence comes from malaria rapid diagnostics, with variable results. While rapid tests for tuberculosis and visceral leishmaniasis require further implementation studies, more evidence on performance of current tests or development of new alternatives is needed for dengue, Chagas disease, filariasis, leptospirosis, enteric fever, human African trypanosomiasis, schistosomiasis and cholera.
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Affiliation(s)
- Lyda Osorio
- Epidemiology and Population Health Research Group, School of Public Health, Universidad del Valle, Calle 4B No. 36-00 Edif 118 Escuela de Salud Pública, Universidad del Valle Campus San Fernando, Cali, Colombia
| | - Jonny Alejandro Garcia
- Epidemiology and Population Health Research Group, School of Public Health, Universidad del Valle, Calle 4B No. 36-00 Edif 118 Escuela de Salud Pública, Universidad del Valle Campus San Fernando, Cali, Colombia
- School of Medicine, Universidad del Valle, Cali, Colombia
| | - Luis Gabriel Parra
- Epidemiology and Population Health Research Group, School of Public Health, Universidad del Valle, Calle 4B No. 36-00 Edif 118 Escuela de Salud Pública, Universidad del Valle Campus San Fernando, Cali, Colombia
- School of Medicine, Universidad del Valle, Cali, Colombia
| | - Victor Garcia
- Epidemiology and Population Health Research Group, School of Public Health, Universidad del Valle, Calle 4B No. 36-00 Edif 118 Escuela de Salud Pública, Universidad del Valle Campus San Fernando, Cali, Colombia
| | - Laura Torres
- Epidemiology and Population Health Research Group, School of Public Health, Universidad del Valle, Calle 4B No. 36-00 Edif 118 Escuela de Salud Pública, Universidad del Valle Campus San Fernando, Cali, Colombia
| | - Stéphanie Degroote
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Valéry Ridde
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
- French Institute for Research on Sustainable Development (IRD), Paris Descartes University, Population and Development Center (CEPED), Université Paris Sorbonne Cité, National Institute of Health and Medical Research (INSERM), Health, Vulnerabilities and Gender Relations South (SAGESUD), Paris, France
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Zongo S, Farquet V, Ridde V. A qualitative study of health professionals' uptake and perceptions of malaria rapid diagnostic tests in Burkina Faso. Malar J 2016; 15:190. [PMID: 27053188 PMCID: PMC4823903 DOI: 10.1186/s12936-016-1241-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 03/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Since 2012, rapid diagnostic tests (RDT) for malaria have been in use nationwide in Burkina Faso. The objective is to strengthen health professionals’ diagnostic capabilities and promote good therapeutic practices. A qualitative study was conducted to learn about the adoption of this tool in the natural context of a national scale-up policy. Methods This study involved five health centres in two health districts. Twenty-eight individual interviews were conducted in 2013 with health professionals and members of the health district management teams. Health professionals’ RDT use and drug prescription practices were observed during 278 curative care consultations over 5 weeks. Results Health professionals assessed the use of RDT positively as it allowed them to reach clear and accurate diagnoses and above all to deliver appropriate, rational care. However, the introduction of RDTs did not really change their diagnostic practices or prescribing practices for artemisinin-based combination therapy (ACT). They continued to rely predominantly on symptoms in establishing their diagnoses because of doubts regarding the reliability of the tests and the occasional stockouts of RDTs experienced by the health centres. Patients with negative RDT results continued to receive anti-malarial treatments. However, the situation remains quite heterogeneous. Conclusion The use of RDTs points to the co-existence of official standards and different standards applied in practice. Setting up regular supervision activities provided an opportunity to observe and understand the various obstacles encountered by health professionals and to monitor how official directives are put into practice. For efficient use of RDTs and their results, health professionals need information and directives that are up-to-date and standardized.
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Affiliation(s)
- Sylvie Zongo
- Département Socio-Économie et Anthropologie du Développement, Institut des Sciences des Sociétés (INSS-CNRST), 03 BP 7047, Ouagadougou, Burkina Faso. .,University of Montreal Public Health Research Institute (IRSPUM), 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada.
| | - Valérie Farquet
- University of Montreal Public Health Research Institute (IRSPUM), 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada
| | - Valéry Ridde
- University of Montreal Public Health Research Institute (IRSPUM), 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada
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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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