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Hidle A, Brennan T, Garon J, An Q, Loharikar A, Marembo J, Manangazira P, Mejia N, Abimbola T. Cost of human papillomavirus vaccine delivery at district and health facility levels in Zimbabwe: A school-based vaccination program targeting multiple cohorts. Vaccine 2022; 40 Suppl 1:A67-A76. [PMID: 35181152 PMCID: PMC10495254 DOI: 10.1016/j.vaccine.2022.01.024] [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] [Received: 05/06/2021] [Revised: 12/01/2021] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND After a pilot project in 2014-15 Zimbabwe introduced the human papillomavirus (HPV) vaccine nationally in 2018 for girls aged 10-14 years through a primarily school-based vaccination campaign with two doses administered at 12-month intervals. In 2019, a first dose was delivered to a new cohort of girls in grade 5 of girls age 10 years if out-of-school (OOS), along with a second dose to the 2018 multiple cohorts. Additional effort was made to identify and mobilize OOS girls by Village Health Workers (VHWs) in the community. Zimbabwe reported 1,569,905 doses of HPV vaccine administered during the 2018 and 2019 campaigns. This analysis evaluated the cost of Zimbabwe's national HPV vaccine introduction. METHODS A retrospective, incremental, ingredients-based cost analysis from the provider perspective was conducted in 2018 and 2019. Financial and economic cost data were collected at district and health facility levels using a two-stage cluster sampling approach and four cost dimensions: program activity, resource input, payer, and administrative level. Costs are presented in 2020 US$ in total and per dose. RESULTS The total weighted costs for combined district and health facility administrative levels were US$ 828,731 (financial) and US$ 2,060,943 (economic). For service delivery, the total weighted cost per dose was US$ 0.16 (financial) and US$ 0.59 (economic). The program activities with the largest share of total weighted financial cost were training (37% of total) and service delivery (30%), while the largest shares of total weighted economic costs were service delivery (45%) and training (19%). Efforts by VHWs to reach OOS girls resulted in an additional US$ 2.99 in financial cost per dose and US$ 7.79 in economic cost per dose. CONCLUSION The service delivery cost per dose was lower than that documented in the pilot program cost analysis in Zimbabwe and studies elsewhere, reflecting a campaign delivery approach that spread fixed costs over a large vaccination cohort. The additional cost of reaching OOS girls with the HPV vaccine was documented for the first time in low- and middle-income countries, which may provide information on potential costs for other countries.
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Affiliation(s)
| | | | | | - Qian An
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anagha Loharikar
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joan Marembo
- Government of Zimbabwe, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Portia Manangazira
- Government of Zimbabwe, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Nelly Mejia
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Taiwo Abimbola
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Brennan T, Hidle A, Doshi RH, An Q, Loharikar A, Casey R, Badiane O, Ndiaye A, Diallo A, Loko Roka J, Mejia N, Abimbola T. Cost of human papillomavirus vaccine delivery in a single-age cohort, routine-based vaccination program in Senegal. Vaccine 2022; 40 Suppl 1:A77-A84. [PMID: 34955325 PMCID: PMC10496089 DOI: 10.1016/j.vaccine.2021.11.057] [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] [Received: 05/06/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In 2018, Senegal introduced human papillomavirus (HPV) vaccine into its routine immunization program for all nine-year-old girls nationwide. We evaluated the costs of Senegal's introduction of HPV vaccine via this delivery approach. METHODS We conducted a retrospective, incremental, ingredients-based cost evaluation from the provider perspective. The study timeframe included Senegal's first planning meeting in 2018 through data collection in early 2020. We collected costs from all involved units at the national and regional levels. A multi-stage cluster sampling approach was used to obtain a nationally representative sample of districts and health facilities. Weights were applied to costs from sampled units to estimate costs across all units. The cost evaluation was based on four dimensions: program activity, resource input, payer, and administrative level. Total costs were divided by the number of HPV doses administered to determine cost per dose and per dimension. RESULTS Excluding vaccine program activity costs, the total financial and economic delivery costs of Senegal's HPV vaccination program were US$ 1,152,351 and US$ 2,838,466, respectively (US$ 3.07 and US$ 7.56 per dose, respectively). A total of 375,608 HPV vaccine doses were administered during the cost evaluation. Training and per diem represented the largest shares of financial costs. Service delivery and personnel time accounted for the largest shares of economic costs. By administrative level, district and health facility levels had the largest shares of financial and economic costs, respectively. Senegal's Ministry of Health accounted for the largest share of financial and economic costs. Including vaccine program activity costs (US$ 4.68/per dose), the total financial cost was US$ 2,911,343 (US$ 7.75 per dose). CONCLUSION This cost evaluation can support Senegal's future vaccine introductions and inform other countries planning to introduce HPV vaccine nationwide. These findings support previous costing studies which anticipated potential economies of scale during the transition from HPV vaccine pilot demonstration projects to national introduction.
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Affiliation(s)
| | | | - Reena H Doshi
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Qian An
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anagha Loharikar
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Casey
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ousseynou Badiane
- Government of Senegal, Ministry of Health and Social Action, Dakar, Senegal
| | - Alassane Ndiaye
- Government of Senegal, Ministry of Health and Social Action, Dakar, Senegal
| | - Aliou Diallo
- World Health Organization - Senegal, Dakar, Senegal
| | - Jerlie Loko Roka
- Senegal Centers for Disease Control and Prevention, Dakar, Senegal
| | - Nelly Mejia
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Taiwo Abimbola
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Biya O, Archer WR, Rayner J, Welwean R, Jegede A, Jacenko S, Pallas S, Abimbola T, Ward K, Wiesen E. An assessment of the contribution of National Stop Transmission of Polio Program to Nigeria's Immunization Program. Pan Afr Med J 2021; 40:1. [PMID: 36157560 PMCID: PMC9474955 DOI: 10.11604/pamj.supp.2021.40.1.15816] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 02/06/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction In July 2012, the National Stop Transmission of Polio (NSTOP) program was established to support the Government of Nigeria in interrupting transmission of poliovirus and strengthen routine immunization (RI). NSTOP has approximately 300 staff members with the majority based at the Local Government Area (LGA) level in northern Nigeria. Methods An internal assessment of NSTOP was conducted from November 2015 to February 2016 to document the program´s contribution to Nigeria´s immunization program and plan future NSTOP engagement. A mixed methods design was used, with data gathered from health facility, LGA, state, and national levels, through structured surveys, interviews, focus group discussions, and review of program records. Survey and expenditure data were summarized by frequency and trends over time, while interview and focus group data were analyzed qualitatively for key themes. Results The majority of the 111 non-NSTOP LGA respondents reported that NSTOP officers supported polio campaigns (100%) and supervised RI sessions (99.1%). Out of 181 respondents at health facility level, the majority reported that NSTOP trainings improved their knowledge (83.3%) and skills (76.2%) on RI, and NSTOP officers regularly supervised their RI sessions (96.7%). Most respondents reported that there would be a negative impact on immunization activities if NSTOP officers were withdrawn. Conclusion Future implementation of NSTOP should be realigned to (a) give highest priority to mentoring LGA staff to build institutional capacity, (b) ensure increased capacity translates to improved provision of RI services, and (c) improve routine review of program monitoring data to assess progress in both polio and RI programs.
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Affiliation(s)
- Oladayo Biya
- Polio Eradication Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States of America,,Corresponding author: Oladayo Biya, Polio Eradication Branch, Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA.
| | - Wiedad Roodly Archer
- Polio Eradication Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Julia Rayner
- Control of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, England
| | - Ralph Welwean
- Polio Eradication Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States of America
| | | | - Sara Jacenko
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Sarah Pallas
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Taiwo Abimbola
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Kirsten Ward
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Eric Wiesen
- Polio Eradication Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States of America
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Ozawa S, Yemeke TT, Mitgang E, Wedlock PT, Higgins C, Chen HH, Pallas SW, Abimbola T, Wallace A, Bartsch SM, Lee BY. Systematic review of the costs for vaccinators to reach vaccination sites: Incremental costs of reaching hard-to-reach populations. Vaccine 2021; 39:4598-4610. [PMID: 34238610 PMCID: PMC10680154 DOI: 10.1016/j.vaccine.2021.05.019] [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] [Received: 01/03/2021] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Economic evidence on how much it may cost for vaccinators to reach populations is important to plan vaccination programs. Moreover, knowing the incremental costs to reach populations that have traditionally been undervaccinated, especially those hard-to-reach who are facing supply-side barriers to vaccination, is essential to expanding immunization coverage to these populations. METHODS We conducted a systematic review to identify estimates of costs associated with getting vaccinators to all vaccination sites. We searched PubMed and the Immunization Delivery Cost Catalogue (IDCC) in 2019 for the following costs to vaccinators: (1) training costs; (2) labor costs, per diems, and incentives; (3) identification of vaccine beneficiary location; and (4) travel costs. We assessed if any of these costs were specific to populations that are hard-to-reach for vaccination, based on a framework for examining supply-side barriers to vaccination. RESULTS We found 19 studies describing average vaccinator training costs at $0.67/person vaccinated or targeted (SD $0.94) and $0.10/dose delivered (SD $0.07). The average cost for vaccinator labor and incentive costs across 29 studies was $2.15/dose (SD $2.08). We identified 13 studies describing intervention costs for a vaccinator to know the location of a beneficiary, with an average cost of $19.69/person (SD $26.65), and six studies describing vaccinator travel costs, with an average cost of $0.07/dose (SD $0.03). Only eight of these studies described hard-to-reach populations for vaccination; two studies examined incremental costs per dose to reach hard-to-reach populations, which were 1.3-2 times higher than the regular costs. The incremental cost to train vaccinators was $0.02/dose, and incremental labor costs for targeting hard-to-reach populations were $0.16-$1.17/dose. CONCLUSION Additional comparative costing studies are needed to understand the potential differential costs for vaccinators reaching the vaccination sites that serve hard-to-reach populations. This will help immunization program planners and decision-makers better allocate resources to extend vaccination programs.
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Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth Mitgang
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Patrick T Wedlock
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Colleen Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Hui-Han Chen
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah W Pallas
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Taiwo Abimbola
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Aaron Wallace
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
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Yemeke TT, Mitgang E, Wedlock PT, Higgins C, Chen HH, Pallas SW, Abimbola T, Wallace A, Bartsch SM, Lee BY, Ozawa S. Promoting, seeking, and reaching vaccination services: A systematic review of costs to immunization programs, beneficiaries, and caregivers. Vaccine 2021; 39:4437-4449. [PMID: 34218959 PMCID: PMC10711749 DOI: 10.1016/j.vaccine.2021.05.075] [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] [Received: 01/03/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Understanding the costs to increase vaccination demand among under-vaccinated populations, as well as costs incurred by beneficiaries and caregivers for reaching vaccination sites, is essential to improving vaccination coverage. However, there have not been systematic analyses documenting such costs for beneficiaries and caregivers seeking vaccination. METHODS We searched PubMed, Scopus, and the Immunization Delivery Cost Catalogue (IDCC) in 2019 for the costs for beneficiaries and caregivers to 1) seek and know how to access vaccination (i.e., costs to immunization programs for social mobilization and interventions to increase vaccination demand), 2) take time off from work, chores, or school for vaccination (i.e., productivity costs), and 3) travel to vaccination sites. We assessed if these costs were specific to populations that faced other non-cost barriers, based on a framework for defining hard-to-reach and hard-to-vaccinate populations for vaccination. RESULTS We found 57 studies describing information, education, and communication (IEC) costs, social mobilization costs, and the costs of interventions to increase vaccination demand, with mean costs per dose at $0.41 (standard deviation (SD) $0.83), $18.86 (SD $50.65) and $28.23 (SD $76.09) in low-, middle-, and high-income countries, respectively. Five studies described productivity losses incurred by beneficiaries and caregivers seeking vaccination ($38.33 per person; SD $14.72; n = 3). We identified six studies on travel costs incurred by beneficiaries and caregivers attending vaccination sites ($11.25 per person; SD $9.54; n = 4). Two studies reported social mobilization costs per dose specific to hard-to-reach populations, which were 2-3.5 times higher than costs for the general population. Eight studies described barriers to vaccination among hard-to-reach populations. CONCLUSION Social mobilization/IEC costs are well-characterized, but evidence is limited on costs incurred by beneficiaries and caregivers getting to vaccination sites. Understanding the potential incremental costs for populations facing barriers to reach vaccination sites is essential to improving vaccine program financing and planning.
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Affiliation(s)
- Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth Mitgang
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY 10027, USA
| | - Patrick T Wedlock
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY 10027, USA
| | - Colleen Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Hui-Han Chen
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah W Pallas
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Taiwo Abimbola
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Aaron Wallace
- Global Immunization Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY 10027, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY 10027, USA
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
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Abstract
This article presents a selection of practical issues, questions, and tradeoffs in methodological choices to consider when conducting a cost of illness (COI) study on enteric fever in low- to lower-middle-income countries. The experiences presented are based on 2 large-scale COI studies embedded within the Surveillance for Enteric Fever in Asia Project II (SEAP II), in Bangladesh, Nepal, and Pakistan; and the Severe Typhoid Fever Surveillance in Africa (SETA) Program in Burkina Faso, Ethiopia, Ghana, and Madagascar. Issues presented include study design choices such as controlling for background patient morbidity and healthcare costs, time points for follow-up, data collection methods for sensitive income and spending information, estimating enteric fever-specific health facility cost information, and analytic approaches in combining patient and health facility costs. The article highlights the potential tradeoffs in time, budget, and precision of results to assist those commissioning, conducting, and interpreting enteric fever COI studies.
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Affiliation(s)
- Nelly Mejia
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Enusa Ramani
- Policy and Economic Research Department, Public Health, Access and Vaccine Epidemiology Unit, International Vaccine Institute, Seoul, Korea
| | - Sarah W Pallas
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dayoung Song
- Policy and Economic Research Department, Public Health, Access and Vaccine Epidemiology Unit, International Vaccine Institute, Seoul, Korea
| | - Taiwo Abimbola
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vittal Mogasale
- Policy and Economic Research Department, Public Health, Access and Vaccine Epidemiology Unit, International Vaccine Institute, Seoul, Korea
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Mejia N, Pallas SW, Saha S, Udin J, Sayeed KMI, Garrett DO, Date K, Abimbola T. Typhoid and Paratyphoid Cost of Illness in Bangladesh: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II. Clin Infect Dis 2020; 71:S293-S305. [PMID: 33258940 PMCID: PMC7750988 DOI: 10.1093/cid/ciaa1334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We conducted a cost of illness study to assess the economic burden of pediatric enteric fever (typhoid and paratyphoid) in Bangladesh. Results can inform public health policies to prevent enteric fever. METHODS The study was conducted at 2 pediatric health facilities in Dhaka. For the patient and caregiver's perspective, we administered questionnaires on costs incurred from illness onset until the survey dates to caregivers of patients with blood culture positive cases at enrollment and 6 weeks later to estimate the direct medical, direct nonmedical, and indirect costs. From the perspective of the health care provider, we collected data on quantities and prices of resources used by the 2 hospitals to estimate the direct medical economic costs to treat a case of enteric fever. We collected costs in Bangladeshi takas and converted them into 2018 US dollars. We multiplied the unit cost per procedure by the frequency of procedures in the surveillance case cohort to calculate the average cost per case. RESULTS Among the 1772 patients from whom we collected information, the median cost of illness per case of enteric fever from the patient and caregiver perspective was US $64.03 (IQR: US $33.90 -$173.48). Median direct medical and nonmedical costs per case were 3% of annual labor income across the sample. From the perspective of the healthcare provider, the average direct medical cost per case was US $58.64 (range: US $37.25 at Hospital B, US $73.27 at Hospital A). CONCLUSIONS Our results show substantial economic burden of enteric fever in Bangladesh, with higher costs for patients receiving inpatient care. As antimicrobial resistance increases globally, the cost of illness could increase, due to more expensive and potent drugs required for treatment.
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Affiliation(s)
- Nelly Mejia
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sarah W Pallas
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Samir Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Jamal Udin
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Kashmira Date
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Taiwo Abimbola
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Mejia N, Qamar F, Yousafzai MT, Raza J, Garrett DO, Date K, Abimbola T, Pallas SW. Typhoid and Paratyphoid Cost of Illness in Pakistan: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II. Clin Infect Dis 2020; 71:S319-S335. [PMID: 33258941 PMCID: PMC7750929 DOI: 10.1093/cid/ciaa1336] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The objective of this study was to estimate the cost of illness from enteric fever (typhoid and paratyphoid) at selected sites in Pakistan. METHODS We implemented a cost-of-illness study in 4 hospitals as part of the Surveillance for Enteric Fever in Asia Project (SEAP) II in Pakistan. From the patient and caregiver perspective, we collected direct medical, nonmedical, and indirect costs per case of enteric fever incurred since illness onset by phone after enrollment and 6 weeks later. From the health care provider perspective, we collected data on quantities and prices of resources used at 3 of the hospitals, to estimate the direct medical economic costs to treat a case of enteric fever. We collected costs in Pakistani rupees and converted them into 2018 US dollars. We multiplied the unit cost per procedure by the frequency of procedures in the surveillance case cohort to calculate the average cost per case. RESULTS We collected patient and caregiver information for 1029 patients with blood culture-confirmed enteric fever or with a nontraumatic terminal ileal perforation, with a median cost of illness per case of US $196.37 (IQR, US $72.89-496.40). The median direct medical and nonmedical costs represented 8.2% of the annual labor income. From the health care provider perspective, the estimated average direct medical cost per case was US $50.88 at Hospital A, US $52.24 at Hospital B, and US $11.73 at Hospital C. CONCLUSIONS Enteric fever can impose a considerable economic burden in Pakistan. These new estimates of the cost of illness of enteric fever can improve evaluation and modeling of the costs and benefits of enteric fever prevention and control measures, including typhoid conjugate vaccines.
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Affiliation(s)
- Nelly Mejia
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Kashmira Date
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Taiwo Abimbola
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah W Pallas
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Mejia N, Abimbola T, Andrews JR, Vaidya K, Tamrakar D, Pradhan S, Shakya R, Garrett DO, Date K, Pallas SW. Typhoid and Paratyphoid Cost of Illness in Nepal: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II. Clin Infect Dis 2020; 71:S306-S318. [PMID: 33258938 PMCID: PMC7750979 DOI: 10.1093/cid/ciaa1335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Enteric fever is endemic in Nepal and its economic burden is unknown. The objective of this study was to estimate the cost of illness due to enteric fever (typhoid and paratyphoid) at selected sites in Nepal. METHODS We implemented a study at 2 hospitals in Nepal to estimate the cost per case of enteric fever from the perspectives of patients, caregivers, and healthcare providers. We collected direct medical, nonmedical, and indirect costs per blood culture-confirmed case incurred by patients and their caregivers from illness onset until after enrollment and 6 weeks later. We estimated healthcare provider direct medical economic costs based on quantities and prices of resources used to diagnose and treat enteric fever, and procedure frequencies received at these facilities by enrolled patients. We collected costs in Nepalese rupees and converted them into 2018 US dollars. RESULTS We collected patient and caregiver cost of illness information for 395 patients, with a median cost of illness per case of $59.99 (IQR, $24.04-$151.23). Median direct medical and nonmedical costs per case represented ~3.5% of annual individual labor income. From the healthcare provider perspective, the average direct medical economic cost per case was $79.80 (range, $71.54 [hospital B], $93.43 [hospital A]). CONCLUSIONS Enteric fever can impose a considerable economic burden on patients, caregivers, and health facilities in Nepal. These new estimates of enteric fever cost of illness can improve evaluation and modeling of the costs and benefits of enteric fever-prevention measures.
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Affiliation(s)
- Nelly Mejia
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Taiwo Abimbola
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Sailesh Pradhan
- Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Rajani Shakya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Kashmira Date
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah W Pallas
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lee BY, Brown ST, Haidari LA, Clark S, Abimbola T, Pallas SE, Wallace AS, Mitgang EA, Leonard J, Bartsch SM, Yemeke TT, Zenkov E, Ozawa S. Economic value of vaccinating geographically hard-to-reach populations with measles vaccine: A modeling application in Kenya. Vaccine 2019; 37:2377-2386. [PMID: 30922700 PMCID: PMC6487493 DOI: 10.1016/j.vaccine.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 06/01/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Since special efforts are necessary to vaccinate people living far from fixed vaccination posts, decision makers are interested in knowing the economic value of such efforts. METHODS Using our immunization geospatial information system platform and a measles compartment model, we quantified the health and economic value of a 2-dose measles immunization outreach strategy for children <24 months of age in Kenya who are geographically hard-to-reach (i.e., those living outside a specified catchment radius from fixed vaccination posts, which served as a proxy for access to services). FINDINGS When geographically hard-to-reach children were not vaccinated, there were 1427 total measles cases from 2016 to 2020, resulting in $9.5 million ($3.1-$18.1 million) in direct medical costs and productivity losses and 7504 (3338-12,903) disability-adjusted life years (DALYs). The outreach strategy cost $76 ($23-$142)/DALY averted (compared to no outreach) when 25% of geographically hard-to-reach children received MCV1, $122 ($40-$226)/DALY averted when 50% received MCV1, and $274 ($123-$478)/DALY averted when 100% received MCV1. CONCLUSION Outreach vaccination among geographically hard-to-reach populations was highly cost-effective in a wide variety of scenarios, offering support for investment in an effective outreach vaccination strategy.
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Affiliation(s)
- Bruce Y Lee
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States.
| | - Shawn T Brown
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States; McGill Centre for Integrative Neuroscience, McGill Neurological Institute, McGill University, Montreal, Canada
| | - Leila A Haidari
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States
| | - Samantha Clark
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, United States
| | - Taiwo Abimbola
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Sarah E Pallas
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Aaron S Wallace
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Elizabeth A Mitgang
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States
| | - Jim Leonard
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States
| | - Sarah M Bartsch
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, United States
| | - Eli Zenkov
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, United States; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, United States
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11
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Erondu NA, Ferland L, Haile BH, Abimbola T. A systematic review of vaccine preventable disease surveillance cost studies. Vaccine 2019; 37:2311-2321. [PMID: 30902482 DOI: 10.1016/j.vaccine.2019.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 03/17/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Planning and monitoring vaccine introduction and effectiveness relies on strong vaccine-preventable disease (VPD) surveillance. In low and middle-income countries (LMICs) especially, cost is a commonly reported barrier to VPD surveillance system maintenance and performance; however, it is rarely calculated or assessed. This review describes and compares studies on the availability of cost information for VPD surveillance systems in LMICs to facilitate the design of future cost studies of VPD surveillance. METHODS PubMed, Web of Science, and EconLit were used to identify peer-reviewed articles and Google was searched for relevant grey literature. Studies selected described characteristics and results of VPD surveillance systems cost studies performed in LMICs. Studies were categorized according to the type of VPD surveillance system, study aim, the annual cost of the system, and per capita costs. RESULTS Eleven studies were identified that assessed the cost of VPD surveillance systems. The studies assessed systems from six low-income countries, two low-middle-income countries, and three middle-income countries. The majority of the studies (n = 7) were conducted in sub-Saharan Africa and fifteen distinct VPD surveillance systems were assessed across the studies. Most studies aimed to estimate incremental costs of additional surveillance components and presented VPD surveillance system costs as mean annual costs per resource category, health structure level, and by VPD surveillance activity. Staff time/personnel cost represents the largest cost driver, ranging from 21% to 61% of total VPD surveillance system costs across nine studies identifying a cost driver. CONCLUSIONS This review provides a starting point to guide LMICs to invest and advocate for more robust VPD surveillance systems. Critical gaps were identified including limited information on the cost of laboratory surveillance, challenges with costing shared resources, and missing data on capital costs. Appropriate guidance is needed to guide LMICs conducting studies on VPD surveillance system costs.
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Affiliation(s)
- Ngozi Adaeze Erondu
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; The Global Bridge Group, LLC, Pleasanton, CA, USA.
| | - Lisa Ferland
- The Global Bridge Group, LLC, Pleasanton, CA, USA
| | | | - Taiwo Abimbola
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
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12
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Hidle A, Gwati G, Abimbola T, Pallas SW, Hyde T, Petu A, McFarland D, Manangazira P. Cost of a human papillomavirus vaccination project, Zimbabwe. Bull World Health Organ 2018; 96:834-842. [PMID: 30505031 PMCID: PMC6249702 DOI: 10.2471/blt.18.211904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 03/28/2018] [Revised: 09/14/2018] [Accepted: 09/20/2018] [Indexed: 01/01/2023] Open
Abstract
Objective To determine the cost of Zimbabwe’s human papillomavirus (HPV) vaccination demonstration project. Methods The government of Zimbabwe conducted the project from 2014–2015, delivering two doses of HPV vaccine to 10-year-old girls in two districts. School delivery was the primary vaccination strategy, with health facilities and outreach as secondary strategies. A retrospective cost analysis was conducted from the provider perspective. Financial costs (government expenditure) and economic costs (financial plus the value of existing or donated resources including vaccines) were calculated by activity, per dose and per fully immunized girl. Results The project delivered 11 599 vaccine doses, resulting in 5724 fully immunized girls (5540 at schools, 168 at health facilities and 16 at outreach points). The financial cost for service delivery per fully immunized girl was United States dollars (US$) 5.34 in schools, US$ 34.90 at health facilities and US$ 288.63 at outreach; the economic costs were US$ 17.39, US$ 41.25 and US$ 635.84, respectively. The mean financial cost per dose was US$ 19.76 and per fully immunized girl was US$ 40.03 (economic costs were US$ 45.00 and US$ 91.19, respectively). The largest number of doses delivered (5788) occurred during the second vaccination round (the second group’s first dose concurrently delivered with the first group’s second dose), resulting in the lowest financial and economic service delivery costs per dose: US$ 1.97 and US$ 6.79, respectively. Conclusion The mean service delivery cost was lower in schools (primary strategy) and when more girls were vaccinated in each round, demonstrating scale efficiency.
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Affiliation(s)
- Anna Hidle
- United States Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop H24-2, Atlanta Georgia, 30329, United States of America (USA)
| | - Gwati Gwati
- Ministry of Health and Child Care, Government of Zimbabwe, Harare, Zimbabwe
| | - Taiwo Abimbola
- United States Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop H24-2, Atlanta Georgia, 30329, United States of America (USA)
| | - Sarah W Pallas
- United States Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop H24-2, Atlanta Georgia, 30329, United States of America (USA)
| | - Terri Hyde
- United States Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop H24-2, Atlanta Georgia, 30329, United States of America (USA)
| | - Amos Petu
- Immunization Financing Sustainability, InterCountry Support Team, East & Southern Africa, World Health Organization, Harare, Zimbabwe
| | | | - Portia Manangazira
- Ministry of Health and Child Care, Government of Zimbabwe, Harare, Zimbabwe
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13
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Routh JA, Sreenivasan N, Adhikari BB, Andrecy LL, Bernateau M, Abimbola T, Njau J, Jackson E, Juin S, Francois J, Tohme RA, Meltzer MI, Katz MA, Mintz ED. Cost Evaluation of a Government-Conducted Oral Cholera Vaccination Campaign-Haiti, 2013. Am J Trop Med Hyg 2017; 97:37-42. [PMID: 29064362 PMCID: PMC5676633 DOI: 10.4269/ajtmh.16-1023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Indexed: 11/07/2022] Open
Abstract
The devastating 2010 cholera epidemic in Haiti prompted the government to introduce oral cholera vaccine (OCV) in two high-risk areas of Haiti. We evaluated the direct costs associated with the government's first vaccine campaign implemented in August-September 2013. We analyzed data for major cost categories and assessed the efficiency of available campaign resources to vaccinate the target population. For a target population of 107,906 persons, campaign costs totaled $624,000 and 215,295 OCV doses were dispensed. The total vaccine and operational cost was $2.90 per dose; vaccine alone cost $1.85 per dose, vaccine delivery and administration $0.70 per dose, and vaccine storage and transport $0.35 per dose. Resources were greater than needed-our analyses suggested that approximately 2.5-6 times as many persons could have been vaccinated during this campaign without increasing the resources allocated for vaccine delivery and administration. These results can inform future OCV campaigns in Haiti.
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Affiliation(s)
- Janell A Routh
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
| | - Nandini Sreenivasan
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
| | - Bishwa B Adhikari
- Division of Preparedness and Emerging Infections, National Center for Emerging Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lesly L Andrecy
- Field Epidemiology Training Program, Direction d'Epidémiologie de Laboratoire et de Recherches (DELR), Ministère de la Santé Publique et de la Population (MSPP), Port-au-Prince, Haiti
| | - Margarette Bernateau
- Field Epidemiology Training Program, Direction d'Epidémiologie de Laboratoire et de Recherches (DELR), Ministère de la Santé Publique et de la Population (MSPP), Port-au-Prince, Haiti
| | - Taiwo Abimbola
- Global Immunizations Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph Njau
- Global Immunizations Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Stanley Juin
- US Centers for Disease Control and Prevention, US Embassy, Port-au-Prince, Haiti
| | - Jeannot Francois
- Directeur du Programme Elargi de Vaccination (DPEV), MSPP, Ave Maïs Gaté, Port-au-Prince, Haiti
| | - Rania A Tohme
- Global Immunizations Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark A Katz
- US Centers for Disease Control and Prevention, US Embassy, Port-au-Prince, Haiti
| | - Eric D Mintz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
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14
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Holmes M, Abimbola T, Lusiana M, Pallas S, Hampton LM, Widyastuti R, Muas I, Karlina K, Kosen S. Resource Needs for the Trivalent Oral Polio to Bivalent Oral Polio Vaccine Switch in Indonesia. J Infect Dis 2017; 216:S209-S216. [PMID: 28838204 PMCID: PMC5853418 DOI: 10.1093/infdis/jix073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background. We present an empirical economic cost analysis of the April 2016 switch from trivalent (tOPV) to bivalent (bOPV) oral polio vaccine at the national-level and 3 provinces (Bali, West Sumatera and Nusa Tenggara) for Indonesia’s Expanded Program on Immunization. Methods. Data on the quantity and prices of resources used in the 4 World Health Organization guideline phases of the switch were collected at the national-level and in each of the sampled provinces, cities/districts, and health facilities. Costs were calculated as the sum of the value of resources reportedly used in each sampled unit by switch phase. Results. Estimated national-level costs were $46 791. Costs by health system level varied from $9062 to $34 256 at the province-level, from $4576 to $11 936 at the district-level , and from $3488 to $29 175 at the city-level. Estimated national costs ranged from $4 076 446 (Bali, minimum cost scenario) to $28 120 700 (West Sumatera, maximum cost scenario). Conclusions. Our findings suggest that the majority of tPOV to bOPV switch costs were borne at the subnational level. Considerable variation in reported costs among health system levels surveyed indicates a need for flexibility in budgeting for globally synchronized public health activities.
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Affiliation(s)
- Marionette Holmes
- Global Immunization Division, US Centers for Disease Control and Prevention.,Economics Department, Spelman College, Atlanta, Georgia
| | - Taiwo Abimbola
- Global Immunization Division, US Centers for Disease Control and Prevention
| | | | - Sarah Pallas
- Global Immunization Division, US Centers for Disease Control and Prevention
| | - Lee M Hampton
- Global Immunization Division, US Centers for Disease Control and Prevention
| | | | - Idawati Muas
- Policy Unit, Ministry of Health, Jakarta, Indonesia
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15
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Gupta S, Abimbola T, Date A, Suthar AB, Bennett R, Sangrujee N, Granich R. Cost-effectiveness of the Three I's for HIV/TB and ART to prevent TB among people living with HIV. Int J Tuberc Lung Dis 2015; 18:1159-65. [PMID: 25216828 DOI: 10.5588/ijtld.13.0571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of the Three I's for HIV/TB (human immunodeficiency virus/tuberculosis): antiretroviral therapy (ART), intensified TB case finding (ICF), isoniazid preventive treatment (IPT), and TB infection control (IC). METHODS Using a 3-year decision-analytic model, we estimated the cost-effectiveness of a base scenario (55% ART coverage at CD4 count ⩿350 cells/mm(3)) and 19 strategies that included one or more of the following: 1) 90% ART coverage, 2) IC and 3) ICF using four-symptom screening and 6- or 36-month IPT. The TB diagnostic algorithm included 1) sputum smear microscopy with chest X-ray, and 2) Xpert® MTB/RIF. RESULTS In resource-constrained settings with a high burden of HIV and TB, the most cost-effective strategies under both diagnostic algorithms included 1) 55% ART coverage and IC, 2) 55% ART coverage, IC and 36-month IPT, and 3) expanded ART at 90% coverage with IC and 36-month IPT. The latter averted more TB cases than other scenarios with increased ART coverage, IC, 6-month IPT and/or IPT for tuberculin skin test positive individuals. The cost-effectiveness results did not change significantly under the sensitivity analyses. CONCLUSION Expanded ART to 90% coverage, IC and a 36-month IPT strategy averted most TB cases and is among the cost-effective strategies.
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Affiliation(s)
- S Gupta
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - T Abimbola
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A Date
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A B Suthar
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Cape Town, South Africa
| | - R Bennett
- Independent Consultant, Huntingdon, UK
| | - N Sangrujee
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - R Granich
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
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