1
|
Suraratdecha C, MacKellar D, Steiner C, Rwabiyago OE, Cham HJ, Msumi O, Maruyama H, Kundi G, Byrd J, Weber R, Mkemwa G, Kazaura K, Justman J, Rwebembera A. Cost-outcome analysis of HIV testing and counseling, linkage, and defaulter tracing services in Bukoba, Tanzania. AIDS Care 2024; 36:744-751. [PMID: 37607238 PMCID: PMC10881889 DOI: 10.1080/09540121.2023.2247959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Effective services along the HIV continuum of care from HIV testing and counseling to linkage, and from linkage to antiretroviral therapy (ART) initiation and retention, are key to improved health outcomes of persons living with HIV. A comprehensive analysis of the costs and outcomes of cascade services is needed to help allocate and prioritize resources to achieve UNAIDS targets. We evaluated the costs and population-level impact of a community-wide, integrated scale-up of testing, linkage, and defaulter-tracing programs implemented in Bukoba Municipal Council, Tanzania. Costs per identified HIV-positive client for provider-initiated, and home- and venue-based testing and counseling were $92.64 United States dollars (USD), $256.33 USD, and $281.57 USD, respectively. Costs per patient linked to HIV care and ART were $47.69 USD and $74.12 USD, respectively, during all ART-eligibility periods combined. Costs per defaulter traced and returned to HIV care were $47.56 USD and $206.77 USD, respectively. The provider-initiated testing and counseling was the most cost-effective modality. Testing approaches targeted to populations groups and geographic location with high testing positivity rates may improve the overall efficiency of testing services. The expansion of ART eligibility criteria and high linkage rate also result in efficiency gains and economies of scale of linkage services.
Collapse
Affiliation(s)
- Chutima Suraratdecha
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Duncan MacKellar
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Haddi Jatou Cham
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Omari Msumi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | - Gerald Kundi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | - Rachel Weber
- Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Grace Mkemwa
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | | | - Anath Rwebembera
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| |
Collapse
|
2
|
Ochieng W, Suraratdecha C. HIV self-testing, PrEP, and drug resistance: some insights. Lancet HIV 2024; 11:e134-e136. [PMID: 38301669 DOI: 10.1016/s2352-3018(23)00290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 02/03/2024]
Affiliation(s)
- Walter Ochieng
- Office of the Director, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | - Chutima Suraratdecha
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| |
Collapse
|
3
|
Suraratdecha C, MacKellar D, Hlophe T, Dlamini M, Ujamaa D, Pals S, Dube L, Williams D, Byrd J, Mndzebele P, Behel S, Pathmanathan I, Mazibuko S, Tilahun E, Ryan C. Evaluation of Community-Based, Mobile HIV-Care, Peer-Delivered Linkage Case Management in Manzini Region, Eswatini. Int J Environ Res Public Health 2022; 20:38. [PMID: 36612360 PMCID: PMC9820019 DOI: 10.3390/ijerph20010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
The success of antiretroviral therapy (ART) requires continuous engagement in care and optimal levels of adherence to achieve sustained HIV viral suppression. We evaluated HIV-care cascade costs and outcomes of a community-based, mobile HIV-care, peer-delivered linkage case-management program (CommLink) implemented in Manzini region, Eswatini. Abstraction teams visited referral facilities during July 2019-April 2020 to locate, match, and abstract the clinical data of CommLink clients diagnosed between March 2016 and March 2018. An ingredients-based costing approach was used to assess economic costs associated with CommLink. The estimated total CommLink costs were $2 million. Personnel costs were the dominant component, followed by travel, commodities and supplies, and training. Costs per client tested positive were $499. Costs per client initiated on ART within 7, 30, and 90 days of diagnosis were $2114, $1634, and $1480, respectively. Costs per client initiated and retained on ART 6, 12, and 18 months after diagnosis were $2343, $2378, and $2462, respectively. CommLink outcomes and costs can help inform community-based HIV testing, linkage, and retention programs in other settings to strengthen effectiveness and improve efficiency.
Collapse
Affiliation(s)
- Chutima Suraratdecha
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Duncan MacKellar
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Thabo Hlophe
- Eswatini Ministry of Health, Mbabane P.O. Box 5, Eswatini
| | | | | | - Sherri Pals
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Lenhle Dube
- Eswatini Ministry of Health, Mbabane P.O. Box 5, Eswatini
| | - Daniel Williams
- U.S. Centers for Disease Control and Prevention, Pretoria P.O. Box 9536, South Africa
| | | | - Phumzile Mndzebele
- U.S. Centers for Disease Control and Prevention, Mbabane P.O. Box D202, Eswatini
| | - Stephanie Behel
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Ishani Pathmanathan
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Sikhathele Mazibuko
- U.S. Centers for Disease Control and Prevention, Mbabane P.O. Box D202, Eswatini
| | - Endale Tilahun
- Population Services International, Mbabane P.O. Box 170, Eswatini
| | - Caroline Ryan
- U.S. Centers for Disease Control and Prevention, Mbabane P.O. Box D202, Eswatini
| |
Collapse
|
4
|
Lukobo-Durrell M, Aladesanmi L, Suraratdecha C, Laube C, Grund J, Mohan D, Kabila M, Kaira F, Habel M, Hines JZ, Mtonga H, Chituwo O, Conkling M, Chipimo PJ, Kachimba J, Toledo C. Maximizing the Impact of Voluntary Medical Male Circumcision for HIV Prevention in Zambia by Targeting High-Risk Men: A Pre/Post Program Evaluation. AIDS Behav 2022; 26:3597-3606. [PMID: 35900708 PMCID: PMC9550704 DOI: 10.1007/s10461-022-03767-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 01/26/2023]
Abstract
A well-documented barrier to voluntary medical male circumcision (VMMC) is financial loss due to the missed opportunity to work while undergoing and recovering from VMMC. We implemented a 2-phased outcome evaluation to explore how enhanced demand creation and financial compensation equivalent to 3 days of missed work influence uptake of VMMC among men at high risk of HIV exposure in Zambia. In Phase 1, we implemented human-centered design-informed interpersonal communication. In Phase 2, financial compensation of ZMW 200 (~ US$17) was added. The proportion of men undergoing circumcision was significantly higher in Phase 2 compared to Phase 1 (38% vs 3%). The cost of demand creation and compensation per client circumcised was $151.54 in Phase 1 and $34.93 in Phase 2. Financial compensation is a cost-effective strategy for increasing VMMC uptake among high-risk men in Zambia, and VMMC programs may consider similar interventions suited to their context.
Collapse
Affiliation(s)
- M Lukobo-Durrell
- Jhpiego, Baltimore, MD, USA. .,Jhpiego, 1615 Thames Street, MD, 21231, Baltimore, USA.
| | | | - C Suraratdecha
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - J Grund
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Mohan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - M Habel
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Z Hines
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - O Chituwo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - M Conkling
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - P J Chipimo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - C Toledo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
5
|
MacKellar D, Hlophe T, Ujamaa D, Pals S, Dlamini M, Dube L, Suraratdecha C, Williams D, Byrd J, Tobias J, Mndzebele P, Behel S, Pathmanathan I, Mazibuko S, Tilahun E, Ryan C. Antiretroviral therapy initiation and retention among clients who received peer-delivered linkage case management and standard linkage services, Eswatini, 2016-2020: retrospective comparative cohort study. Arch Public Health 2022; 80:74. [PMID: 35260189 PMCID: PMC8905856 DOI: 10.1186/s13690-022-00810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persons living with HIV infection (PLHIV) who are diagnosed in community settings in sub-Saharan Africa are particularly vulnerable to barriers to care that prevent or delay many from obtaining antiretroviral therapy (ART). METHODS We conducted a retrospective cohort study to assess if a package of peer-delivered linkage case management and treatment navigation services (CommLink) was more effective than peer-delivered counseling, referral, and telephone follow-up (standard linkage services, SLS) in initiating and retaining PLHIV on ART after diagnosis in community settings in Eswatini. HIV-test records of 773 CommLink and 769 SLS clients aged ≥ 15 years diagnosed between March 2016 and March 2018, matched by urban and rural settings of diagnosis, were selected for the study. CommLink counselors recorded resolved and unresolved barriers to care (e.g., perceived wellbeing, fear of partner response, stigmatization) during a median of 52 days (interquartile range: 35-69) of case management. RESULTS Twice as many CommLink than SLS clients initiated ART by 90 days of diagnosis overall (88.4% vs. 37.9%, adjusted relative risk (aRR): 2.33, 95% confidence interval (CI): 1.97, 2.77) and during test and treat when all PLHIV were eligible for ART (96.2% vs. 37.1%, aRR: 2.59, 95% CI: 2.20, 3.04). By 18 months of diagnosis, 54% more CommLink than SLS clients were initiated and retained on ART (76.3% vs. 49.5%, aRR: 1.54, 95% CI: 1.33, 1.79). Peer counselors helped resolve 896 (65%) of 1372 identified barriers of CommLink clients. Compared with clients with ≥ 3 unresolved barriers to care, 42% (aRR: 1.42, 95% CI: 1.19, 1.68) more clients with 1-2 unresolved barriers, 44% (aRR: 1.44, 95% CI: 1.25, 1.66) more clients with all barriers resolved, and 54% (aRR: 1.54, 95% CI: 1.30, 1.81) more clients who had no identified barriers were initiated and retained on ART by 18 months of diagnosis. CONCLUSIONS To improve early ART initiation and retention among PLHIV diagnosed in community settings, HIV prevention programs should consider providing a package of peer-delivered linkage case management and treatment navigation services. Clients with multiple unresolved barriers to care measured as part of that package should be triaged for differentiated linkage and retention services.
Collapse
Affiliation(s)
- Duncan MacKellar
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | - Sherri Pals
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lenhle Dube
- Eswatini Ministry of Health, Mbabane, Eswatini
| | - Chutima Suraratdecha
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel Williams
- U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | | | - James Tobias
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Stephanie Behel
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ishani Pathmanathan
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Caroline Ryan
- U.S. Centers for Disease Control and Prevention, Mbabane, Eswatini
| |
Collapse
|
6
|
Chingombe I, Mapingure MP, Balachandra S, Chipango TN, Gambanga F, Mushavi A, Apollo T, Suraratdecha C, Rogers JH, Ruangtragool L, Gonese E, Musuka GN, Mugurungi OM, Harris TG. Patient costs for prevention of mother-to-child HIV transmission and antiretroviral therapy services in public health facilities in Zimbabwe. PLoS One 2021; 16:e0256291. [PMID: 34407129 PMCID: PMC8372940 DOI: 10.1371/journal.pone.0256291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Abstract
Zimbabwe has made large strides in addressing HIV. To ensure a continued robust response, a clear understanding of costs associated with its HIV program is critical. We conducted a cross-sectional evaluation in 2017 to estimate the annual average patient cost for accessing Prevention of Mother-To-Child Transmission (PMTCT) services (through antenatal care) and Antiretroviral Treatment (ART) services in Zimbabwe. Twenty sites representing different types of public health facilities in Zimbabwe were included. Data on patient costs were collected through in-person interviews with 414 ART and 424 PMTCT adult patients and through telephone interviews with 38 ART and 47 PMTCT adult patients who had missed their last appointment. The mean and median annual patient costs were examined overall and by service type for all participants and for those who paid any cost. Potential patient costs related to time lost were calculated by multiplying the total time to access services (travel time, waiting time, and clinic visit duration) by potential earnings (US$75 per month assuming 8 hours per day and 5 days per week). Mean annual patient costs for accessing services for the participants was US$20.00 [standard deviation (SD) = US$80.42, median = US$6.00, range = US$0.00-US$12,18.00] for PMTCT and US$18.73 (SD = US$58.54, median = US$8.00, range = US$0.00-US$ 908.00) for ART patients. The mean annual direct medical costs for PMTCT and ART were US$9.78 (SD = US$78.58, median = US$0.00, range = US$0.00-US$ 90) and US$7.49 (SD = US$60.00, median = US$0.00) while mean annual direct non-medical cost for US$10.23 (SD = US$17.35, median = US$4.00) and US$11.23 (SD = US$25.22, median = US$6.00, range = US$0.00-US$ 360.00). The PMTCT and ART costs per visit based on time lost were US$3.53 (US$1.13 to US$8.69) and US$3.43 (US$1.14 to US$8.53), respectively. The mean annual patient costs per person for PMTCT and ART in this evaluation will impact household income since PMTCT and ART services in Zimbabwe are supposed to be free.
Collapse
Affiliation(s)
- Innocent Chingombe
- ICAP at Columbia University, New York, NY, United States of America
- * E-mail:
| | | | | | | | - Fiona Gambanga
- ICAP at Columbia University, New York, NY, United States of America
| | | | | | - Chutima Suraratdecha
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia United States of America
| | - John H. Rogers
- U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Leala Ruangtragool
- PHI/CDC Global HIV Surveillance Fellow, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Elizabeth Gonese
- U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | | | | |
Collapse
|
7
|
Davis SM, Owuor N, Odoyo-June E, Wambua J, Omanga E, Lukobo M, Laube C, Mwandi Z, Suraratdecha C, Kioko UM, Rotich W, Kataka J, Ng’eno C, Mohan D, Toledo C, Aoko A, Anyango J, Oneya D, Orenjuro K, Mgamb E, Serrem K, Juma A. Making voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1. PLoS One 2021; 16:e0252725. [PMID: 34115784 PMCID: PMC8195380 DOI: 10.1371/journal.pone.0252725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/20/2021] [Indexed: 01/02/2023] Open
Abstract
Voluntary medical male circumcision is a crucial HIV prevention program for men in sub-Saharan Africa. Kenya is one of the first countries to achieve high population coverage and seek to transition the program to a more sustainable structure designed to maintain coverage while making all aspects of service provision domestically owned and implemented. Using pre-defined metrics, we created and evaluated three models of circumcision service delivery (static, mobile and mixed) to identify which had potential for sustaining high circumcision coverage among 10-14-year-olds group, a historically high-demand and accessible age group, at the lowest possible cost. We implemented each model in two distinct geographic areas, one in Siaya and the other in Migori county, and assessed multiple aspects of each model's sustainability. These included numerical achievements against targets designed to reach 80% coverage over two years; quantitative expenditure outcomes including unit expenditure plus its primary drivers; and qualitative community perception of program quality and sustainability based on Likert scale. Outcome values at baseline were compared with those for year one of model implementation using bivariate linear regression, unpaired t-tests and Wilcoxon rank tests as appropriate. Across models, numerical target achievement ranged from 45-140%, with the mixed models performing best in both counties. Unit expenditures varied from approximately $57 in both countries at baseline to $44-$124 in year 1, with the lowest values in the mixed and static models. Mean key informant perception scores generally rose significantly from baseline to year 1, with a notable drop in the area of community engagement. Consistently low scores were in the aspects of domestic financing for service provision. Sustainability-focused circumcision service delivery models can successfully achieve target volumes at lower unit expenditures than existing models, but strategies for domestic financing remain a crucial challenge to address for long-term maintenance of the program.
Collapse
Affiliation(s)
- Stephanie M. Davis
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Elijah Odoyo-June
- US Centers for Disease Control and Prevention, Nairobi, Kenya
- * E-mail:
| | | | | | - Mainza Lukobo
- Jhpiego, Baltimore, Maryland, United States of America
| | | | | | - Chutima Suraratdecha
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Jacquin Kataka
- Center for Health Solutions, Shinda Project, Siaya, Kenya
| | - Caroline Ng’eno
- University of Maryland, Baltimore, Maryland, United States of America
- Timiza Project, Migori, Kenya
| | - Diwakar Mohan
- Jhpiego, Baltimore, Maryland, United States of America
| | - Carlos Toledo
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Appolonia Aoko
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | | | | | | | - Kennedy Serrem
- National STD/AIDS Control Program (NASCOP), Ministry of Health, Nairobi, Kenya
| | - Ambrose Juma
- National STD/AIDS Control Program (NASCOP), Ministry of Health, Nairobi, Kenya
| |
Collapse
|
8
|
Suraratdecha C, Stuart RM, Edwards M, Moore R, Liu N, Wilson DP, Albalak R. Costs of providing HIV care and optimal allocation of HIV resources in Guyana. PLoS One 2020; 15:e0238499. [PMID: 33119591 PMCID: PMC7595312 DOI: 10.1371/journal.pone.0238499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Great strides in responding to the HIV epidemic have led to improved access to and uptake of HIV services in Guyana, a lower-middle-income country with a generalized HIV epidemic. Despite efforts to scale up HIV treatment and adopt the test and start strategy, little is known about costs of HIV services across the care cascade. METHODS We collected cost data from the national laboratory and nine selected treatment facilities in five of the country's ten Regions, and estimated the costs associated with HIV testing and services (HTS) and antiretroviral therapy (ART) from a provider perspective from January 1, 2016 to December 31, 2016. We then used the unit costs to construct four resource allocation scenarios. In the first two scenarios, we calculated how close Guyana would currently be to its 2020 targets if the allocation of funding across programs and regions over 2017-2020 had (a) remained unchanged from latest-reported levels, or (b) been optimally distributed to minimize incidence and deaths. In the next two, we estimated the resources that would have been required to meet the 2020 targets if those resources had been distributed (a) according to latest-reported patterns, or (b) optimally to minimize incidence and deaths. RESULTS The mean cost per test was US$15 and the mean cost per person tested positive was US$796. The mean annual cost per of maintaining established adult and pediatric patients on ART were US$428 and US$410, respectively. The mean annual cost of maintaining virally suppressed patients was US$648. Cost variation across sites may suggest opportunities for improvements in efficiency, or may reflect variation in facility type and patient volume. There may also be scope for improvements in allocative efficiency; we estimated a 28% reduction in the total resources required to meet Guyana's 2020 targets if funds had been optimally distributed to minimize infections and deaths. CONCLUSIONS We provide the first estimates of costs along the HIV cascade in the Caribbean and assessed efficiencies using novel context-specific data on the costs associated with diagnostic, treatment, and viral suppression. The findings call for better targeting of services, and efficient service delivery models and resource allocation, while scaling up HIV services to maximize investment impact.
Collapse
Affiliation(s)
- Chutima Suraratdecha
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robyn M. Stuart
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
- Burnet Institute, Melbourne, Australia
- * E-mail:
| | | | | | - Nadia Liu
- Ministry of Public Health, Georgetown, Guyana
| | - David P. Wilson
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
- Monash University, Melbourne, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Microbial Pathogenesis, University of Maryland, Baltimore, United States of America
| | - Rachel Albalak
- U.S. Centers for Disease Control and Prevention, Caribbean Region Office, Barbados, Santo Domingo, Dominican Republic
| |
Collapse
|
9
|
Cham HJ, MacKellar D, Maruyama H, Rwabiyago OE, Msumi O, Steiner C, Kundi G, Weber R, Byrd J, Suraratdecha C, Mengistu T, Churi E, Pals S, Madevu-Matson C, Alexander G, Porter S, Kazaura K, Mbilinyi D, Morales F, Rutachunzibwa T, Justman J, Rwebembera A. Methods, outcomes, and costs of a 2.5 year comprehensive facility-and community-based HIV testing intervention in Bukoba Municipal Council, Tanzania, 2014-2017. PLoS One 2019; 14:e0215654. [PMID: 31048912 PMCID: PMC6497243 DOI: 10.1371/journal.pone.0215654] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/07/2019] [Indexed: 11/18/2022] Open
Abstract
To diagnose ≥90% HIV-infected residents (diagnostic coverage), the Bukoba Combination Prevention Evaluation (BCPE) implemented provider-initiated (PITC), home- (HBHTC), and venue-based (VBHTC) HIV testing and counseling (HTC) intervention in Bukoba Municipal Council, a mixed urban and rural lake zone community of 150,000 residents in Tanzania. This paper describes the methods, outcomes, and incremental costs of these HTC interventions. PITC was implemented in outpatient department clinics in all eight public and three faith-based health facilities. In clinics, lay counselors routinely screened and referred eligible patients for HIV testing conducted by HTC-dedicated healthcare workers. In all 14 wards, community teams offered HTC to eligible persons encountered at 31,293 home visits and at 79 male- and youth-frequented venues. HTC was recommended for persons who were not in HIV care or had not tested in the prior 90 days. BCPE conducted 133,695 HIV tests during the 2.5 year intervention (PITC: 88,813, 66%; HBHTC: 27,407, 21%; VBHTC: 17,475, 13%). Compared with other strategies, PITC conducted proportionally more tests among females (65%), and VBHTC conducted proportionally more tests among males (69%) and young-adults aged 15-24 years (42%). Of 5,550 (4.2% of all tests) HIV-positive tests, 4,143 (75%) clients were newly HIV diagnosed, including 1,583 males and 881 young adults aged 15-24 years. Of HIV tests conducted 3.7%, 1.8%, and 2.1% of PITC, HBHTC, and VBHTC clients, respectively, were newly HIV diagnosed; PITC accounted for 79% of all new diagnoses. Cost per test (per new diagnosis) was $4.55 ($123.66), $6.45 ($354.44), and $7.98 ($372.67) for PITC, HBHTC, and VBHTC, respectively. In a task-shifting analysis in which lay counselors replaced healthcare workers, estimated costs per test (per new diagnosis) would have been $3.06 ($83.15), $ 4.81 ($264.04), and $5.45 ($254.52), for PITC, HBHTC, and VBHTC, respectively. BCPE models reached different target groups, including men and young adults, two groups with consistently low coverage. Implementation of multiple models is likely necessary to achieve ≥90% diagnostic coverage.
Collapse
Affiliation(s)
- Haddi Jatou Cham
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Duncan MacKellar
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Omari Msumi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | - Gerald Kundi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | - Rachel Weber
- U.S. Centers for Disease Control and Prevention, Yaounde, Cameroon
| | - Johnita Byrd
- ICF International, Atlanta, Georgia, United States of America
| | - Chutima Suraratdecha
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tewodaj Mengistu
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eliufoo Churi
- Henry Jackson Foundation Medical Research International, Mbeya, Tanzania
| | - Sherri Pals
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Sarah Porter
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kokuhumbya Kazaura
- U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | | | | | - Thomas Rutachunzibwa
- Ministry of Health, Community Development, Gender, Elderly and Children, Bukoba, Tanzania
| | | | - Anath Rwebembera
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| |
Collapse
|
10
|
Lasry A, Bachanas P, Suraratdecha C, Alwano MG, Behel S, Pals S, Block L, Moore J. Cost of Community-Based HIV Testing Activities to Reach Saturation in Botswana. AIDS Behav 2019; 23:875-882. [PMID: 30673897 DOI: 10.1007/s10461-019-02408-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In Botswana, 85% of persons living with HIV are aware of their status. We performed an economic analysis of HIV testing activities implemented during intensive campaigns, in 11 communities, between April 2015 and March 2016, through the Botswana Combination Prevention Project. The total cost was $1,098,312, or $99,847 per community, with 60% attributable to home-based testing and 40% attributable to mobile testing. The cost per person tested was $44, and $671 per person testing positive (2017 USD). Labor costs comprised 64% of total costs. In areas of high HIV prevalence and treatment coverage, the cost of untargeted home-based testing may be inflated by the efforts required to assess the testing eligibility of clients who are HIV-positive and on ART. Home-based and mobile testing delivered though an intensive community-based campaign allowed the identification of HIV positive persons, who may not access health facilities, at a cost comparable to other studies.
Collapse
Affiliation(s)
- Arielle Lasry
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-04, Atlanta, GA, 30329-4018, USA.
| | - Pamela Bachanas
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-04, Atlanta, GA, 30329-4018, USA
| | - Chutima Suraratdecha
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-04, Atlanta, GA, 30329-4018, USA
| | - Mary Grace Alwano
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-04, Atlanta, GA, 30329-4018, USA
| | - Stephanie Behel
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-04, Atlanta, GA, 30329-4018, USA
| | - Sherri Pals
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-04, Atlanta, GA, 30329-4018, USA
| | - Lisa Block
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-04, Atlanta, GA, 30329-4018, USA
| | - Janet Moore
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-04, Atlanta, GA, 30329-4018, USA
| |
Collapse
|
11
|
MacKellar D, Maruyama H, Rwabiyago OE, Steiner C, Cham H, Msumi O, Weber R, Kundi G, Suraratdecha C, Mengistu T, Byrd J, Pals S, Churi E, Madevu-Matson C, Kazaura K, Morales F, Rutachunzibwa T, Justman J, Rwebembera A. Implementing the package of CDC and WHO recommended linkage services: Methods, outcomes, and costs of the Bukoba Tanzania Combination Prevention Evaluation peer-delivered, linkage case management program, 2014-2017. PLoS One 2018; 13:e0208919. [PMID: 30543693 PMCID: PMC6292635 DOI: 10.1371/journal.pone.0208919] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022] Open
Abstract
Although several studies have evaluated one or more linkage services to improve early enrollment in HIV care in Tanzania, none have evaluated the package of linkage services recommended by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). We describe the uptake of each component of the CDC/WHO recommended package of linkage services, and early enrollment in HIV care and antiretroviral therapy (ART) initiation among persons with HIV who participated in a peer-delivered, linkage case management (LCM) program implemented in Bukoba, Tanzania, October 2014 –May 2017. Of 4206 participants (88% newly HIV diagnosed), most received recommended services including counseling on the importance of early enrollment in care and ART (100%); escort by foot or car to an HIV care and treatment clinic (CTC) (83%); treatment navigation at a CTC (94%); telephone support and appointment reminders (77% among clients with cellphones); and counseling on HIV-status disclosure and partner/family testing (77%), and on barriers to care (69%). During three periods with different ART-eligibility thresholds [CD4<350 (Oct 2014 –Dec 2015, n = 2233), CD4≤500 (Jan 2016 –Sept 2016, n = 1221), and Test & Start (Oct 2016 –May 2017, n = 752)], 90%, 96%, and 97% of clients enrolled in HIV care, and 47%, 67%, and 86% of clients initiated ART, respectively, within three months of diagnosis. Of 463 LCM clients who participated in the last three months of the rollout of Test & Start, 91% initiated ART. Estimated per-client cost was $44 United States dollars (USD) for delivering LCM services in communities and facilities overall, and $18 USD for a facility-only model with task shifting. Well accepted by persons with HIV, peer-delivered LCM services recommended by CDC and WHO can achieve near universal early ART initiation in the Test & Start era at modest cost and should be considered for implementation in facilities and communities experiencing <90% early enrollment in ART care.
Collapse
Affiliation(s)
- Duncan MacKellar
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | | | | | | | - Haddi Cham
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Omari Msumi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | - Rachel Weber
- CTS Global, Inc., assigned to Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Gerald Kundi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | - Chutima Suraratdecha
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tewodaj Mengistu
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Sherri Pals
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eliufoo Churi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | | | | | | | - Jessica Justman
- ICAP at Columbia University, New York, New York, United States of America
| | - Anath Rwebembera
- National AIDS Control Program, MoHCDGEC, Dar es Salaam, Tanzania
| |
Collapse
|
12
|
Suraratdecha C, Stuart RM, Manopaiboon C, Green D, Lertpiriyasuwat C, Wilson DP, Pavaputanon P, Visavakum P, Monkongdee P, Khawcharoenporn T, Tharee P, Kittinunvorakoon C, Martin M. Cost and cost-effectiveness analysis of pre-exposure prophylaxis among men who have sex with men in two hospitals in Thailand. J Int AIDS Soc 2018; 21 Suppl 5:e25129. [PMID: 30033559 PMCID: PMC6055129 DOI: 10.1002/jia2.25129] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/17/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In 2014, the Government of Thailand recommended pre-exposure prophylaxis (PrEP) as an additional HIV prevention programme within Thailand's National Guidelines on HIV/AIDS Treatment Prevention. However, to date implementation and uptake of PrEP programmes have been limited, and evidence on the costs and the epidemiological and economic impact is not available. METHODS We estimated the costs associated with PrEP provision among men having sex with men (MSM) participating in a facility-based, prospective observational cohort study: the Test, Treat and Prevent HIV Programme in Thailand. We created a suite of scenarios to estimate the cost-effectiveness of PrEP and sensitivity of the results to the model input parameters, including PrEP programme effectiveness, PrEP uptake among high-risk and low-risk MSM, baseline and future antiretroviral therapy (ART) coverage, condom use, unit cost of delivering PrEP, and the discount rate. RESULTS Drug costs accounted for 82.5% of the total cost of providing PrEP, followed by lab testing (8.2%) and personnel costs (7.8%). The estimated costs of providing the PrEP package in accordance with the national recommendation ranges from US$223 to US$311 per person per year. Based on our modelling results, we estimate that PrEP would be cost-effective when provided to either high-risk or all MSM. However, we found that the programme would be approximately 32% more cost-effective if offered to high-risk MSM than it would be if offered to all MSM, with an incremental cost-effectiveness ratio of US$4,836 per disability-adjusted life years (DALY) averted and US$7,089 per DALY averted respectively. Cost-effectiveness acceptability curves demonstrate that 80% of scenarios would be cost-effective when PrEP is provided solely to higher-risk MSM. CONCLUSION We provide the first estimates on cost and cost-effectiveness of PrEP in the Asia-Pacific region, and offer insights on how to deliver PrEP in combination with ART. While the high drug cost poses a budgeting challenge, incorporating PrEP delivery into an existing ART programme could be a cost-effective strategy to prevent HIV infections among MSM in Thailand.
Collapse
Affiliation(s)
- Chutima Suraratdecha
- Division of Global HIV and TBCenters for Disease Control and PreventionAtlantaGAUSA
| | - Robyn M Stuart
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Mathematical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Chomnad Manopaiboon
- Division of Global HV and TBThailand Ministry of Public Health‐U.S. CDC CollaborationNonthaburiThailand
| | - Dylan Green
- Division of Global HIV and TBCenters for Disease Control and PreventionAtlantaGAUSA
| | | | | | | | - Prin Visavakum
- Division of Global HV and TBThailand Ministry of Public Health‐U.S. CDC CollaborationNonthaburiThailand
| | - Patama Monkongdee
- Division of Global HV and TBThailand Ministry of Public Health‐U.S. CDC CollaborationNonthaburiThailand
| | - Thana Khawcharoenporn
- Division of Infectious DiseasesFaculty of MedicineThammasat UniversityPathumthaniThailand
| | | | | | - Michael Martin
- Division of Global HIV and TBCenters for Disease Control and PreventionAtlantaGAUSA
- Division of Global HV and TBThailand Ministry of Public Health‐U.S. CDC CollaborationNonthaburiThailand
| |
Collapse
|
13
|
Chang AY, Riumallo-Herl C, Perales NA, Clark S, Clark A, Constenla D, Garske T, Jackson ML, Jean K, Jit M, Jones EO, Li X, Suraratdecha C, Bullock O, Johnson H, Brenzel L, Verguet S. The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries. Health Aff (Millwood) 2018; 37:316-324. [PMID: 29401021 DOI: 10.1377/hlthaff.2017.0861] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With social policies increasingly directed toward enhancing equity through health programs, it is important that methods for estimating the health and economic benefits of these programs by subpopulation be developed, to assess both equity concerns and the programs' total impact. We estimated the differential health impact (measured as the number of deaths averted) and household economic impact (measured as the number of cases of medical impoverishment averted) of ten antigens and their corresponding vaccines across income quintiles for forty-one low- and middle-income countries. Our analysis indicated that benefits across these vaccines would accrue predominantly in the lowest income quintiles. Policy makers should be informed about the large health and economic distributional impact that vaccines could have, and they should view vaccination policies as potentially important channels for improving health equity. Our results provide insight into the distribution of vaccine-preventable diseases and the health benefits associated with their prevention.
Collapse
Affiliation(s)
- Angela Y Chang
- Angela Y. Chang ( ) was a doctor of science candidate in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts, at the time this article was completed. Currently she is a postdoctoral fellow at the Institute for Health Metrics and Evaluation, University of Washington, in Seattle
| | - Carlos Riumallo-Herl
- Carlos Riumallo-Herl was a doctor of science candidate in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, at the time this article was completed. Currently he is a postdoctoral fellow in the Department of Applied Economics, Erasmus School of Economics, in Rotterdam, the Netherlands
| | - Nicole A Perales
- Nicole A. Perales was a master of science student in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, at the time this article was completed. Currently she is a doctoral student at the University of California, Berkeley
| | - Samantha Clark
- Samantha Clark is a PhD candidate in the Pharmaceutical Outcomes Research and Policy Program, University of Washington
| | - Andrew Clark
- Andrew Clark is an assistant professor in health decision modelling, London School of Hygiene and Tropical Medicine, in the United Kingdom
| | - Dagna Constenla
- Dagna Constenla is an associate scientist and the director of Economics and Finance in the Vaccine Access Center of the Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Tini Garske
- Tini Garske is a lecturer in the MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, in the United Kingdom
| | - Michael L Jackson
- Michael L. Jackson is an associate investigator at the Kaiser Permanente Washington Health Research Institute, in Seattle
| | - Kévin Jean
- Kévin Jean is a lecturer in epidemiology in the laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des Arts et Métiers, in Paris, France, and a visiting lecturer in the MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London
| | - Mark Jit
- Mark Jit is a professor of vaccine epidemiology in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Edward O Jones
- Edward O. Jones was a researcher in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, when this article was completed
| | - Xi Li
- Xi Li is an independent health consultant in Manila, the Philippines
| | | | - Olivia Bullock
- Olivia Bullock is a program officer at Gavi, the Vaccine Alliance, in Geneva, Switzerland
| | - Hope Johnson
- Hope Johnson is director of monitoring and evaluation at Gavi, the Vaccine Alliance
| | - Logan Brenzel
- Logan Brenzel is a senior program officer for economics and finance, Vaccine Delivery/Global Development, Bill & Melinda Gates Foundation, in Washington, D.C
| | - Stéphane Verguet
- Stéphane Verguet is an assistant professor of global health in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health
| |
Collapse
|
14
|
Ozawa S, Clark S, Portnoy A, Grewal S, Stack ML, Sinha A, Mirelman A, Franklin H, Friberg IK, Tam Y, Walker N, Clark A, Ferrari M, Suraratdecha C, Sweet S, Goldie SJ, Garske T, Li M, Hansen PM, Johnson HL, Walker D. Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001-2020. Bull World Health Organ 2017; 95:629-638. [PMID: 28867843 PMCID: PMC5578376 DOI: 10.2471/blt.16.178475] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 12/30/2022] Open
Abstract
Objective To estimate the economic impact likely to be achieved by efforts to vaccinate against 10 vaccine-preventable diseases between 2001 and 2020 in 73 low- and middle-income countries largely supported by Gavi, the Vaccine Alliance. Methods We used health impact models to estimate the economic impact of achieving forecasted coverages for vaccination against Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae and yellow fever. In comparison with no vaccination, we modelled the costs – expressed in 2010 United States dollars (US$) – of averted treatment, transportation costs, productivity losses of caregivers and productivity losses due to disability and death. We used the value-of-a-life-year method to estimate the broader economic and social value of living longer, in better health, as a result of immunization. Findings We estimated that, in the 73 countries, vaccinations given between 2001 and 2020 will avert over 20 million deaths and save US$ 350 billion in cost of illness. The deaths and disability prevented by vaccinations given during the two decades will result in estimated lifelong productivity gains totalling US$ 330 billion and US$ 9 billion, respectively. Over the lifetimes of the vaccinated cohorts, the same vaccinations will save an estimated US$ 5 billion in treatment costs. The broader economic and social value of these vaccinations is estimated at US$ 820 billion. Conclusion By preventing significant costs and potentially increasing economic productivity among some of the world’s poorest countries, the impact of immunization goes well beyond health.
Collapse
Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB # 7574, Beard Hall 115H, Chapel Hill, North Carolina, 27599, United States of America (USA)
| | - Samantha Clark
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Allison Portnoy
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA
| | - Simrun Grewal
- Department of Pharmacy, University of Washington, Seattle, USA
| | | | - Anushua Sinha
- Department of Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, USA
| | - Andrew Mirelman
- Centre for Health Economics, University of York, York, England
| | - Heather Franklin
- Department of Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, USA
| | - Ingrid K Friberg
- Department of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Yvonne Tam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, England
| | - Matthew Ferrari
- Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park, USA
| | | | - Steven Sweet
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, USA
| | - Sue J Goldie
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, USA
| | - Tini Garske
- MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, England
| | - Michelle Li
- Gavi, the Vaccine Alliance, Geneva, Switzerland
| | - Peter M Hansen
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | | | | |
Collapse
|
15
|
Usuf E, Mackenzie G, Sambou S, Atherly D, Suraratdecha C. The economic burden of childhood pneumococcal diseases in The Gambia. Cost Eff Resour Alloc 2016; 14:4. [PMID: 26893592 PMCID: PMC4758012 DOI: 10.1186/s12962-016-0053-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background Streptococcus pneumoniae is a common cause of child death. However, the economic burden of pneumococcal disease in low-income countries is poorly described. We aimed to estimate from a societal perspective, the costs incurred by health providers and families of children with pneumococcal diseases. Methods We recruited children less than 5 years of age with outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and bacterial meningitis at facilities in rural and urban Gambia. We collected provider costs, out of pocket costs and productivity loss for the families of children. For each disease diagnostic category, costs were collected before, during, and for 1 week after discharge from hospital or outpatient visit. Results A total of 340 children were enrolled; 100 outpatient pneumonia, 175 inpatient pneumonia 36 pneumococcal sepsis, and 29 bacterial meningitis cases. The mean provider costs per patient for treating outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis were US$8, US$64, US$87 and US$124 respectively and the mean out of pocket costs per patient were US$6, US$31, US$44 and US$34 respectively. The economic burden of outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis increased to US$15, US$109, US$144 and US$170 respectively when family members’ time loss from work was taken into account. Conclusion The economic burden of pneumococcal disease in The Gambia is substantial, costs to families was approximately one-third to a half of the provider costs, and accounted for up to 30 % of total societal costs. The introduction of pneumococcal conjugate vaccine has the potential to significantly reduce this economic burden in this society. Electronic supplementary material The online version of this article (doi:10.1186/s12962-016-0053-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Effua Usuf
- MRC, The Gambia Unit, PO Box 273, Banjul, Gambia
| | - Grant Mackenzie
- MRC, The Gambia Unit, PO Box 273, Banjul, Gambia ; Pneumococcal Group, Murdoch Children's Research Institute, Parkville, Australia ; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Chutima Suraratdecha
- PATH, Seattle, USA ; U.S. Centers for Disease Control and Prevention, Atlanta, USA
| |
Collapse
|
16
|
McPake B, Edoka I, Witter S, Kielmann K, Taegtmeyer M, Dieleman M, Vaughan K, Gama E, Kok M, Datiko D, Otiso L, Ahmed R, Squires N, Suraratdecha C, Cometto G. Cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya. Bull World Health Organ 2015; 93:631-639A. [PMID: 26478627 PMCID: PMC4581637 DOI: 10.2471/blt.14.144899] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 03/05/2015] [Accepted: 06/19/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya. METHODS Incremental cost-effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value. FINDINGS The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective. CONCLUSION Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.
Collapse
Affiliation(s)
- Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Ijeoma Edoka
- Institute for International Health & Development, Queen Margaret University, Queen Margaret Drive Musselburgh, Edinburgh EH21 6UU, Scotland
| | - Sophie Witter
- Institute for International Health & Development, Queen Margaret University, Queen Margaret Drive Musselburgh, Edinburgh EH21 6UU, Scotland
| | - Karina Kielmann
- Institute for International Health & Development, Queen Margaret University, Queen Margaret Drive Musselburgh, Edinburgh EH21 6UU, Scotland
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England
| | | | | | - Elvis Gama
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England
| | - Maryse Kok
- Royal Tropical Institute, Amsterdam, Netherlands
| | - Daniel Datiko
- REACHOUT, Hidase Hulentenawi Agelglot Yebego Adragot Mahber, Awassa, Ethiopia
| | | | - Rukhsana Ahmed
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England
| | - Neil Squires
- Public Health England, North of England Region, England
| | - Chutima Suraratdecha
- United States Agency for International Development, Washington, DC, United States of America
| | - Giorgio Cometto
- Global Health Workforce Alliance, World Health Organization, Geneva, Switzerland
| |
Collapse
|
17
|
Riewpaiboon A, Sooksriwong C, Chaiyakunapruk N, Tharmaphornpilas P, Techathawat S, Rookkapan K, Rasdjarmrearnsook A, Suraratdecha C. Optimizing national immunization program supply chain management in Thailand: an economic analysis. Public Health 2015; 129:899-906. [PMID: 26027451 DOI: 10.1016/j.puhe.2015.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/06/2015] [Accepted: 04/22/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to conduct an economic analysis of the transition of the conventional vaccine supply and logistics systems to the vendor managed inventory (VMI) system in Thailand. STUDY DESIGN Cost analysis of health care program. METHODS An ingredients based approach was used to design the survey and collect data for an economic analysis of the immunization supply and logistics systems covering procurement, storage and distribution of vaccines from the central level to the lowest level of vaccine administration facility. Costs were presented in 2010 US dollar. RESULTS The total cost of the vaccination program including cost of vaccine procured and logistics under the conventional system was US$0.60 per packed volume procured (cm(3)) and US$1.35 per dose procured compared to US$0.66 per packed volume procured (cm(3)) and US$1.43 per dose procured under the VMI system. However, the findings revealed that the transition to the VMI system and outsourcing of the supply chain system reduced the cost of immunization program at US$6.6 million per year because of reduction of un-opened vaccine wastage. CONCLUSIONS The findings demonstrated that the new supply chain system would result in efficiency improvement and potential savings to the immunization program compared to the conventional system.
Collapse
Affiliation(s)
- A Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand.
| | - C Sooksriwong
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
| | - N Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, USA; School of Population Health, University of Queensland, Brisbane, Australia
| | - P Tharmaphornpilas
- Bureau of General Communicable Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - S Techathawat
- Bureau of General Communicable Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - K Rookkapan
- Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla 90112, Thailand
| | - A Rasdjarmrearnsook
- Bureau of General Communicable Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - C Suraratdecha
- United States Agency for International Development, Washington, DC, USA
| |
Collapse
|
18
|
Lee LA, Franzel L, Atwell J, Datta SD, Friberg IK, Goldie SJ, Reef SE, Schwalbe N, Simons E, Strebel PM, Sweet S, Suraratdecha C, Tam Y, Vynnycky E, Walker N, Walker DG, Hansen PM. The estimated mortality impact of vaccinations forecast to be administered during 2011-2020 in 73 countries supported by the GAVI Alliance. Vaccine 2014; 31 Suppl 2:B61-72. [PMID: 23598494 DOI: 10.1016/j.vaccine.2012.11.035] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 11/04/2012] [Accepted: 11/09/2012] [Indexed: 01/20/2023]
Abstract
INTRODUCTION From August to December 2011, a multidisciplinary group with expertise in mathematical modeling was constituted by the GAVI Alliance and the Bill & Melinda Gates Foundation to estimate the impact of vaccination in 73 countries supported by the GAVI Alliance. METHODS The number of deaths averted in persons projected to be vaccinated during 2011-2020 was estimated for ten antigens: hepatitis B, yellow fever, Haemophilus influenzae type B (Hib), Streptococcus pneumoniae, rotavirus, Neisseria meningitidis serogroup A, Japanese encephalitis, human papillomavirus, measles, and rubella. Impact was calculated as the difference in the number of deaths expected over the lifetime of vaccinated cohorts compared to the number of deaths expected in those cohorts with no vaccination. Numbers of persons vaccinated were based on 2011 GAVI Strategic Demand Forecasts with projected dates of vaccine introductions, vaccination coverage, and target population size in each country. RESULTS By 2020, nearly all GAVI-supported countries with endemic disease are projected to have introduced hepatitis B, Hib, pneumococcal, rotavirus, rubella, yellow fever, N. meningitidis serogroup A, and Japanese encephalitis-containing vaccines; 55 (75 percent) countries are projected to have introduced human papillomavirus vaccine. Projected use of these vaccines during 2011-2020 is expected to avert an estimated 9.9 million deaths. Routine and supplementary immunization activities with measles vaccine are expected to avert an additional 13.4 million deaths. Estimated numbers of deaths averted per 1000 persons vaccinated were highest for first-dose measles (16.5), human papillomavirus (15.1), and hepatitis B (8.3) vaccination. Approximately 52 percent of the expected deaths averted will be in Africa, 27 percent in Southeast Asia, and 13 percent in the Eastern Mediterranean. CONCLUSION Vaccination of persons during 2011-2020 in 73 GAVI-eligible countries is expected to have substantial public health impact, particularly in Africa and Southeast Asia, two regions with high mortality. The actual impact of vaccination in these countries may be higher than our estimates because several widely used antigens were not included in the analysis. The quality of our estimates is limited by lack of data on underlying disease burden and vaccine effectiveness against fatal disease outcomes in developing countries. We plan to update the estimates annually to reflect updated demand forecasts, to refine model assumptions based on results of new information, and to extend the analysis to include morbidity and economic benefits.
Collapse
|
19
|
Drake JK, Thi Thanh LH, Suraratdecha C, Thi Thu HP, Vail JG. Stakeholder perceptions of a total market approach to family planning in Viet Nam. Reprod Health Matters 2011; 18:46-55. [PMID: 21111350 DOI: 10.1016/s0968-8080(10)36529-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Viet Nam has high modern contraceptive prevalence (68%), with most services received through the public sector. As the country transitions to middle-income status, Viet Nam's donors have ceased donations of contraceptive supplies, causing a large projected shortfall in the family planning budget. In response, the Ministry of Health has decided to prioritize free or subsidized contraceptives for poor and vulnerable groups, while enhancing social marketing and sales of contraceptives in the free market. To support planning for this "total market approach", a descriptive exploratory study was conducted with 38 public and private sector family planning stakeholders to gain their perceptions of the proposals. There was a high level of support for government leadership of public-private coordination and stewardship of the entire family planning system. Key information gaps were identified regarding how the reforms can promote equitable access to family planning and financial sustainability in pricing. The government's experience with this transition may yield valuable guidance for other settings.
Collapse
|
20
|
Drake JK, Espinoza H, Suraratdecha C, Lacayo Y, Keith BM, Vail JG. Stakeholder perceptions of a total market approach to family planning in Nicaragua. Rev Panam Salud Publica 2011; 29:329-336. [PMID: 21709937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 02/08/2011] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To assess private-sector stakeholders' and donors' perceptions of a total market approach (TMA) to family planning in Nicaragua in the context of decreased funding; to build evidence for potential strategies and mechanisms for TMA implementation (including public-private partnerships (PPPs)); and to identify information gaps and future priorities for related research and advocacy. METHODS A descriptive exploratory study was conducted in various locations in Nicaragua from March to April 2010. A total of 24 key private-sector stakeholders and donors were interviewed and their responses analyzed using two questionnaires and a stakeholder analysis tool (PolicyMakerTM software). RESULTS All survey participants supported a TMA, and public-private collaboration, in family planning in Nicaragua. Based on the survey responses, opportunities for further developing PPPs for family planning include building on and expanding existing governmental frameworks, such as Nicaragua's current coordination mechanism for contraceptive security. Obstacles include the lack of ongoing government engagement with the commercial (for-profit) sector and confusion about regulations for its involvement in family planning. Strategies for strengthening existing PPPs include establishing a coordination mechanism specifically for the commercial sector and collecting and disseminating evidence supporting public-private collaboration in family planning. CONCLUSIONS There was no formal or absolute opposition to a TMA or PPPs in family planning in Nicaragua among a group of diverse nongovernmental stakeholders and donors. This type of study can help identify strategies to mobilize existing and potential advocates in achieving articulated policy goals, including diversification of funding sources for family planning to achieve contraceptive security.
Collapse
|
21
|
Zhang S, Yin Z, Suraratdecha C, Liu X, Li Y, Hills S, Zhang K, Chen Y, Liang X. Knowledge, attitudes and practices of caregivers regarding Japanese encephalitis in Shaanxi Province, China. Public Health 2011; 125:79-83. [DOI: 10.1016/j.puhe.2010.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 09/08/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
|
22
|
Touch S, Suraratdecha C, Samnang C, Heng S, Gazley L, Huch C, Sovann L, Chhay CS, Soeung SC. A cost-effectiveness analysis of Japanese encephalitis vaccine in Cambodia. Vaccine 2010; 28:4593-9. [PMID: 20470803 DOI: 10.1016/j.vaccine.2010.04.086] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 04/21/2010] [Accepted: 04/27/2010] [Indexed: 11/27/2022]
Abstract
This study aimed to evaluate the cost and effectiveness of introducing a live, attenuated vaccine (SA 14-14-2) against Japanese encephalitis (JE) into the immunization program. The study demonstrated that SA 14-14-2 immunization is cost-effective in controlling JE in Cambodia compared to no vaccination. Averting one disability-adjusted life year, from a societal perspective, through the introduction of SA 14-14-2 through routine immunization, or a combination of routine immunization plus a campaign targeting children 1-5 or 1-10 years of age, costs US$22, US$34 and US$53, respectively. Sensitivity analyses confirmed that there was a high probability of SA 14-14-2 immunization being cost-effective under conditions of uncertainty.
Collapse
Affiliation(s)
- Sok Touch
- Communicable Disease Control Department, Ministry of Health, Cambodia.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Okunade AA, Suraratdecha C, Benson DA. Determinants of Thailand household healthcare expenditure: the relevance of permanent resources and other correlates. Health Econ 2010; 19:365-376. [PMID: 19405046 DOI: 10.1002/hec.1471] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Several papers in the leading health economics journals modeled the determinants of healthcare expenditure using household survey or family budgets data of developed countries. Past work largely used self-reported current income as the core determinant, whereas the theoretically correct concept of household resource constraint is permanent or long-run income (á lá Milton Friedman). This paper strives to rectify the theoretical oversight of using current income by augmenting the model with household asset. Using longitudinal data, we constructed 'wealth index' as a distinct covariate to capture the households' tendency to liquidate assets when defraying necessary healthcare liabilities after exhausting cash incomes. (Current income and assets together capture the household expanded resource base). Using 98 632 household observations from Thailand Socio-Economic Surveys (1994-2000 biennial data cycles) we found, using a double-hurdle model with dependent errors, that out-of-pocket healthcare spending behaves as a technical necessity across income quintiles and household sizes. Pre-1997 economic shock income elasticities are smaller than the post-shock estimates across income quintiles for large and small households. Proximity to death, median age, and assets are also among other significant determinants. Our novel findings extend the theoretical consistency of a multi-level decision model in household healthcare expenditure in the developing Asian country context.
Collapse
Affiliation(s)
- Albert A Okunade
- Department of Economics, The University of Memphis, Memphis, TN 38152, USA.
| | | | | |
Collapse
|
24
|
Zhang SB, Yin ZD, Suraratdecha C, Hills SL, Liu XZ, Li YX, Xia XQ, Liang GD, Liang XF. [Analysis on data from the clinical acute viral encephalitis surveillance system in three prefectures in Shaanxi during 2005 - 2006]. Zhonghua Liu Xing Bing Xue Za Zhi 2008; 29:895-898. [PMID: 19173854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the epidemiological features of viral encephalitis and burden of Japanese encephalitis (JE), and to identify potential strategies for effective JE control measures, using data from the Viral Encephalitis Surveillance Program (VESP) launched in Ankang, Baoji, and Weinan prefectures, Shaanxi province. METHODS Data was gathered from sentinel hospitals reporting system on all the viral encephalitis (VE) cases identified between June 2005 and May 2007. County Center for Disease Control and Prevention (CDC) investigated the cases, drawing blood and cerebrospinal fluid (CSF) samples from the hospitals, and testing IgM antibody against JE using ELISA. We used Epi Data and Excel for data entry and analysis. RESULTS A total of 1097 VEs were reported and 1053 (96.0%) had blood or CSF samples collected and tested for IgM antibody against JE. Three hundred and eleven cases (29.5%) showed JE antibody positive (JE confirmed case). Among the JE confirmed cases, numbers of those under 15 year of age accounted for 33.7%, 43.9% and 88.3% in Baoji, Weinan and Ankang prefectures respectively. The rest were mainly children aged 5-14 years old (53.3%). Toddlers,farmers and children accounted for 85.2% in JE confirmed cases. About half of other VE cases (51.0%) were students of all age. Data an investigation on 398 reported VE cases at discharge, showed that 67.1% of JE confirmed cases recovered while 83.7% of the other VE cases fully recovered. The case fatality rates were 9.2% for JE confirmed cases and 3.1% for other VE cases. 578 cases were followed up at 90-days after discharge, 69.6% of JE confirmed cases and 90.2% of other VE cases recovered, with case fatality rates were 13.6% and 3.6% for JE confirmed cases and for other VE cases, respectively. The sequelae rates were 10.0% for JE confirmed cases and 4.5% for other VE cases. CONCLUSION The peak of the VE season was the same as that of JE. There were 45.6% of reported JE cases with negative JE IgM, suggesting that it is necessary to carry out laboratory testing for clinical diagnosis cases. The fact that high risk population was different at prefectures levels suggested that more attention be paid in JE control and prevention.
Collapse
Affiliation(s)
- Shao-Bai Zhang
- Shaanxi Provincial Center for Disease Control and Prevention, Xi'an 710054, China
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Whittington D, Suraratdecha C, Poulos C, Ainsworth M, Prabhu V, Tangcharoensathien V. Household demand for preventive HIV/AIDS vaccines in Thailand: do husbands' and wives' preferences differ? Value Health 2008; 11:965-974. [PMID: 18194396 DOI: 10.1111/j.1524-4733.2007.00312.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES The aims of this study were to estimate household demand in the general population of Thailand for a (hypothetical) preventive HIV vaccine; to determine whether spouses in the same household would purchase the same number of vaccines for household members and have the same demand function; to determine whether spouses would allocate vaccines to the same household members; and to estimate household and per capita average willingness to pay (WTP) for an HIV vaccine price. METHODS The data come from a national contingent valuation survey of 2524 residents (aged 18-20 years) of 1235 households in Thailand during the period 2000 to 2001. In a subsample of 561 households, both head of household and spouse completed independent (separate) interviews. Respondents were asked whether they would purchase an HIV vaccine for themselves and for other household members if one were available at a specified price. RESULTS For the full sample, average household WTP for the vaccine was substantial (US$610 at 50% vaccine effectiveness, US$671 at 95% effectiveness); the average per capita WTP for household members was US$220 at 50% effectiveness and US$242 at 95% effectiveness. Although spouses reported that they would purchase the same total number of vaccines, and had essentially the same demand functions, at lower vaccine prices wives were significantly more likely than husbands to allocate vaccines to their daughters than to sons. CONCLUSIONS Because wives are more likely to allocate vaccines to daughters, vaccination programs aimed at women and girls might have different outcomes than programs directed at males or at all potential adults without regard to sex.
Collapse
Affiliation(s)
- Dale Whittington
- Department of Environmental Sciences and Engineering, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Suraratdecha C, Ramana CV, Kaipilyawar S, Krishnamurthy, Sivalenka S, Ambatipudi N, Gandhi S, Umashankar K, Cheyne J. Cost and effectiveness analysis of immunization service delivery support in Andhra Pradesh, India. Bull World Health Organ 2008; 86:221-8. [PMID: 18368210 DOI: 10.2471/blt.06.039495] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Accepted: 06/21/2007] [Indexed: 11/27/2022] Open
Abstract
The immunization service delivery support (ISDS) model was initiated in Andhra Pradesh, India, in November 2003 with the aim of strengthening immunization services through supportive supervision. The ISDS model involves a well-established supervision system built upon the existing health infrastructure. The objectives of this approach are to: (1) identify areas of high performance and those that need improvement, (2) assist staff in identifying and correcting wrong practices, (3) improve staff skills, (4) motivate staff, and (5) initiate corrective actions at appropriate levels through information sharing. An evaluation of cost and effectiveness of ISDS in 16 districts that participated in the programme found that the incremental cost associated with three rounds of supportive supervision visits was approximately US$ 110,630 (US$ 36,877 per round). The performance of health centre and immunization sessions was evaluated using 43- and 28-point checklists, respectively, and demonstrated significant improvement during and following the two-year implementation of ISDS. The average percentage change in health centre performance scores from baseline to the fourth round of evaluation was approximately 36%, and immunization session performance scores increased by an average of 9%. The incremental costs per additional per cent increase in average health centre performance score and per additional per cent increase in average immunization session performance score over the evaluation period were estimated to be US$ 3091 and US$ 12,760, respectively. The incremental cost-effectiveness ratios are relatively sensitive to personnel and travel costs. Integration of ISDS into the Andhra Pradesh immunization system is projected to result in a 39% potential cost savings per round of supervision visit.
Collapse
|
27
|
Hecht R, Suraratdecha C. Estimating the demand for a preventive HIV vaccine: why we need to do better. Reliable estimates would help in achieving several policy and advocacy objectives. PLoS Med 2006; 3:e398. [PMID: 16953657 PMCID: PMC1560173 DOI: 10.1371/journal.pmed.0030398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Additional research on public and private demand for HIV vaccines is needed to strengthen ongoing advocacy and planning for eventual vaccine introduction, say Hecht and Suraratdecha.
Collapse
Affiliation(s)
- Robert Hecht
- International AIDS Vaccine Initiative, New York, New York, USA.
| | | |
Collapse
|
28
|
Abstract
This paper constructs and estimates an economic model for testing statistically the strength of possible 'expenditure inertia' as a plausible reason for rising drug expenditures of the Organization for Economic Cooperation and Development (OECD) countries. The ethical drugs sector in the OECD health care systems is increasingly targeted as the major culprit in the rising cost. Using multiple regression analysis, and the maximum likelihood estimation method, the data of each country (taken from OECD Health Data, 1997) were first tested for functional form optimality with the Box-Cox power family transformations model. Drug expenditure elasticities, at data means, were computed using each country's optimal regression model estimates. The results indicate that the traditionally fitted a priori limited functional form models (e.g., linear, log-log) are not globally consistent with data across countries. The effect of a one-period lagged real per-capita drug expenditure (capturing inertia or habit persistence) on current period real per-capita prescription expenditure is statistically significant in most countries. Pharmaceutical demands are inelastic, and tend to behave like a necessity, as expected. Since the significant effects of economic, demographic, and other drivers of high drug spending differ across countries, country-specific implications and policy suggestions for cost controls ought to differ.
Collapse
Affiliation(s)
- Albert A Okunade
- Department of Economics, Rm. 450BB, FCoBE, The University of Memphis, Memphis, TN 38152, USA.
| | | |
Collapse
|
29
|
Suraratdecha C, Okunade AA. Measuring operational efficiency in a health care system: a case study from Thailand. Health Policy 2005; 77:2-23. [PMID: 16150510 DOI: 10.1016/j.healthpol.2005.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 07/01/2005] [Indexed: 11/16/2022]
Abstract
This paper investigates the economic relationship among medical resources and efficiency of the health care system in a developing Asian country. The rapid growth in the use of limited resources and the escalating national health expenditure, raise the critical economic question of whether the use of health care resources are efficient. We estimated a four-factor production system, based on 1982-1997 annual operational data comprising five cross-sectional regions per year. The translog production function and three derived demand for factor input equations were jointly estimated using systems regression method. Results show that different types of medical care workers (doctors, nurses, pharmacists) influenced efficiency differently. The marginal products (MPs) of nurses and capital are the highest and they varied across the regions. Third, the estimates of factor substitution possibilities indicate difficult factor adjustments; these estimates differ in magnitudes and significance across regions but they similarly classify all but one (different) input pair as economic substitutes. Fourth, the regional variations in returns to scale estimates in live births tend to converge to that of the Bangkok metropolis. Finally, technical change is physician and pharmacist labor using, but capital and nursing labor saving. Policy implications of these findings touch on Article 78 of the Thailand Constitution.
Collapse
Affiliation(s)
- Chutima Suraratdecha
- International Health Policy Program, Health Systems Research Institute, Ministry of Public Health, Tiwanon Road, Thailand
| | | |
Collapse
|
30
|
Abstract
A contingent valuation survey of Thai adults revealed that private demand for a hypothetical AIDS vaccine that is safe, has no side effects, and lasts 10 years, rises with income, the lifetime risk of HIV infection and vaccine efficacy, and declines with vaccine price and respondent's age. Demand for both high (95%) and low (50%) efficacy AIDS vaccines is substantial. Nearly 80% of adults would agree to be vaccinated with a free vaccine. Government will have an important role to ensure that those at highest risk of HIV infection with low incomes have access to the vaccine and to reinforce other safe preventive behavior to prevent reductions in condom use.
Collapse
Affiliation(s)
- Chutima Suraratdecha
- International Health Policy Program, Ministry of Public Health, Tiwanon Rd., Nonthaburi, Thailand.
| | | | | | | |
Collapse
|
31
|
Suraratdecha C, Saithanu S, Tangcharoensathien V. Is universal coverage a solution for disparities in health care? Findings from three low-income provinces of Thailand. Health Policy 2004; 73:272-84. [PMID: 16039346 DOI: 10.1016/j.healthpol.2004.11.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Accepted: 11/15/2004] [Indexed: 10/26/2022]
Abstract
The policy on universal coverage (UC) of health care has been adopted and implemented incrementally by the government of Thailand since April 2001 with the aim of providing the access to care for the uninsured population. The success of UC, however, depends on how effective its design and implementation arrangements are in reaching population and affecting households' health seeking behavior and abilities to take up benefits of UC. The results from the household survey of 1834 respondents conducted in three low-income provinces (Tak, Sakol Nakorn, Narathiwat) show that the Gold card with exemption scheme was pro-poor while other insurance schemes tended to favor the rich with 2.6% of respondents reported having more than one type of health insurance coverage and 8.9% without health insurance. The insurance status had statistically significant association with health care use, and knowledge on family planning method and sexually transmitted diseases. Additionally, consumer preferences and socioeconomics factors are a key to disparities in health care utilization.
Collapse
Affiliation(s)
- Chutima Suraratdecha
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand.
| | | | | |
Collapse
|
32
|
Tangcharoensathien V, Phoolcharoen W, Pitayarangsarit S, Kongsin S, Kasemsup V, Tantivess S, Suraratdecha C. The potential demand for an AIDS vaccine in Thailand. Health Policy 2001; 57:111-39. [PMID: 11395178 DOI: 10.1016/s0168-8510(01)00119-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The recent ongoing phase III clinical trial of a preventive vaccine in Thailand has prompted studies on potential demand for the vaccine among public, employers and households. This study aims to demonstrate the impact of HIV/AIDS, estimate the AIDS vaccine budget required and design the vaccination strategies for different population groups. The analysis is based on available secondary data and several assumptions on levels of secondary infections among various risk groups. Among 15 groups, we identified eight groups as potential vaccinees: Direct CSW, IDU in treatment, IDU out of treatment, male STD, transport workers, CSW indirect, conscripts and prisoners. The vaccine budget, excluding other operating expenditure, was estimated based on a single dose regimen ranging from 100 Baht (3 US dollars) to 1000 Baht (29 US dollars) per dose. A total of 1.8-17.7 million US dollars is required for non-infected catch-up population and 0.2-1.9 million US dollars for the maintenance population in the subsequent year. We foresee a relative inefficient and inequitable consumption of AIDS vaccine, which requires proper policy analysis and government interventions. Before vaccine adoption, strong preventive measures must be in place. AIDS vaccine could play an additional, not a substituting, role. A thorough understanding, a wide consultation with stakeholders and public debates are crucial steps for sound policy formulation.
Collapse
Affiliation(s)
- V Tangcharoensathien
- Senior Research Scholar Program in Health Economics and Financing, Health Systems Research Institute, 5th floor Mental Health Dept Bldg., Nonthaburi 11000, Thailand.
| | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
Health care expenditure studies of the Organization for Economic Cooperation and Development (OECD) countries remain important because their findings often suggest cost containment and other policy initiatives. This paper focuses on the compatibility of OECD health data with the "expenditure inertia" (or lagged adjustments) hypothesis, by modeling individual country time-series data of 21 nations for the 1960-1993 period. Maximum likelihood estimates of the Box-Cox transformation regression models reveal that: (a) the hypothesized impact of health "expenditure inertia" is both pervasive and strong, averaging 0.64 across the countries; (b) the real GDP elasticities of health care expenditures vary widely among the countries and average 0.34 in the short run--implying that health care is a necessity; (c) the long run GDP elasticities are less than 1 in 8 countries, unitary elastic in 8 countries and elastic in 5 countries--suggesting that health care is not universally a necessity or a luxury commodity for the OECD countries; (d) physician-inducement effects (dis-inducement in a few countries) are weak, with a mean elasticity estimate of 0.17; and (e) no unique functional form approximation model is globally compatible with the data across the countries. Health care cost containment policy implications of these findings are explored.
Collapse
Affiliation(s)
- A A Okunade
- Department of Economics, University of Memphis, TN 38152, USA.
| | | |
Collapse
|
34
|
Abstract
Specialized hospitals perform unique, technologically more complex, and relatively expensive medical procedures. Growing use of high-cost biotechnology drugs and increased clinical pharmacy tasks at these facilities have increased costs. This paper used a unique data set supplied by Eli Lilly, and a dual translog cost system to model the costs of specialized hospital pharmacy production. Results show that the potential substitution of pharmacy technicians for registered pharmacists and the decomposed technical change savings effects of expensive factors of production offer the greatest opportunities for containing costs. Slight diseconomies of scale were also observed.
Collapse
Affiliation(s)
- A A Okunade
- Department of Economics, University of Memphis, TN 38152, USA.
| | | |
Collapse
|