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Cost-effectiveness analysis of the introduction of the pneumococcal conjugate vaccine (PCV-13) in the Egyptian national immunization program, 2013
Lara, Carlos; Badr, Shaza; Abo Freikha, Saiyed; El-Tantawy, Nasr; Moussa, Ibrahim; Allam, Essam; Baxter, Louise; Sibak, Mohammed; Hoestlandt, Céline; Chaudhri, Irtaza; Munier, Aline; Hajjeh, Rana ( 2015-05-01 )

Pneumonia is one of the most important causes of morbidity and mortality in children under 5 in Egypt, and the Ministry of Health of Egypt is considering introducing pneumococcal conjugate vaccine (PCV) in its national immunization program. We performed an economic analysis to evaluate the cost-effectiveness of this vaccine in Egypt and to provide the decision-makers with needed evidence.The analysis was done using the TRIVAC model. Data included demographic characteristics, burden of disease, coverage and efficacy of the vaccine, health resource utilization, and costs of pneumococcal disease vaccination and treatment. Whenever possible, we used national or regional data. Two alternatives were compared: (1) general vaccination of children younger than 5 years with the 13-valent pneumococcal conjugate vaccine (PCV13), using a three-dose schedule without booster, and (2) no vaccination. Outcomes of 10 cohorts from birth to 5 years were analyzed. The study was performed from the governmental perspective and selected public health providers.In comparison to no vaccine, the introduction of PCV13 would be cost-effective, with an incremental cost-effectiveness ratio of US$ 3916 per disability-adjusted life-year (DALY) averted (government perspective). The total incremental cost of the PCV vaccination program (10 cohorts) would be approximately US$ 1.09 billion. Over the 10 cohorts, the program would avert 8583 pneumococcal deaths - 42% of all pneumococcal-related deaths.The introduction of PCV13 would be a good value for money from the government perspective. It would represent a high-impact public health intervention for Egypt and respond to the National Immunization Technical Advisory Group (NITAG) resolution on reducing pneumonia burden and overall child mortality. Strengthening surveillance will be critical to generating high-quality national data, improving future economic analyses that support evidence-based decisions for introducing vaccines and public health interventions, and to monitoring their impact.

Cost-effectiveness analysis of tuberculosis control policies in Ivanovo Oblast, Russian Federation / G. B. Migliori ... [et al.]
Migliori, Giovanni Battista; Khomenko, A. G; Punga, V. V; Ambrosetti, M; Danilova, I; Ribka, L. N; Grzemska, Malgorzata; Sawert, H; Raviglione, Mario C; Ivanovo Tuberculosis Project Study Group ( 1998 )
Cost-effectiveness and efficacy of CHROMagar [TM] Candida medium in clinical specimens
Momani, O.M. ( 2000 )

CHROMagar[TM] Candida is a new medium for the differential isolation and identification of certain clinically important Candida species. This study evaluated the cost-effectiveness of this medium compared with conventional methods. Thirty reference strains, 158 clinical specimens and 105 stock cultures were investigated. Specimens were cultured on CHROMagar[TM] Candida medium and on Sabouraud chloramphenicol agar. Identification was by conventional methods on Sabouraud agar and appearance of colonies on CHROMagar[TM] Candida medium. CHROMagar[TM] Candida correctly identified isolates of C. albicans, C. tropicalis and C. krusei. It was superior in detecting mixed cultures. A comparison of time and cost was carried out. CHROMagar[TM] Candida provides a simple, accurate and cost-effective method for identifying some clinically important Candida species

Cost-effectiveness of a comprehensive programme for drug-resistant tuberculosis in China
Hui, Zhang; Shitong, Huan; Yunzhou, Ruan; Mingting, Chen; Yanlin, Zhao; Wei, Su; Floyd, Katherine; Alston, Timothy; Chin, Daniel P; Yunting, Fu; Scano, Fabio; Qiang, Sun; Jin, Zhao; Chengfei, Lv; Cheng, Chen; Renzhong, Li; Yan, Qu; Fitzpatrick, Christopher; Lixia, Wang; Caihong, Xu ( 2015-09-14 )

To investigate the cost-effectiveness of a comprehensive programme for drug-resistant tuberculosis launched in four sites in China in 2011.In 2011-2012, we reviewed the records of 172 patients with drug-resistant tuberculosis who enrolled in the comprehensive programme and we collected relevant administrative data from hospitals and China's public health agency. For comparison, we examined a cohort of 81 patients who were treated for drug-resistant tuberculosis in 2006-2009. We performed a cost-effectiveness analysis, from a societal perspective, that included probabilistic uncertainty. We measured early treatment outcomes based on three-month culture results and modelled longer-term outcomes to facilitate estimation of the comprehensive programme's cost per disability-adjusted life-year (DALY) averted.The comprehensive programme cost 8837 United States dollars (US$) per patient treated. Low enrolment rates meant that some fixed costs were higher, per patient, than expected. Although the comprehensive programme appeared 30 times more costly than the previous one, it resulted in greater health benefits. The comprehensive programme, which cost US$ 639 (95% credible interval: 112 to 1322) per DALY averted, satisfied the World Health Organization's criterion for a very cost-effective intervention.The comprehensive programme, which included rapid screening, standardized care and financial protection, improved individual outcomes for MDR tuberculosis in a cost-effective manner. To support post-2015 global heath targets, the comprehensive programme should be expanded to non-residents and other areas of China.

Cost-effectiveness of a tuberculosis active case finding program targeting household and neighborhood contacts in Cambodia
Satha, Peou; Lubell, Yoel; Yadav, Rajendra P; Nishikiori, Nobuyuki; Eang, Mao T ( 2014-03-10 )

In many high-risk populations, access to tuberculosis (TB) diagnosis and treatment is limited and pockets of high prevalence persist. We estimated the cost-effectiveness of an extensive active case finding program in areas of Cambodia where TB notifications and household poverty rates are highest and access to care is restricted. Thirty operational health districts with high TB incidence and household poverty were randomized into intervention and control groups. In intervention operational health districts, all household and symptomatic neighborhood contacts of registered TB patients of the past two years were encouraged to attend screening at mobile centers. In control districts, routine passive case finding activities continued. The program screened more than 35,000 household and neighborhood contacts and identified 810 bacteriologically confirmed cases. The cost-effectiveness analysis estimated that in these cases the reduction in mortality from 14% to 2% would result in a cost per daily adjusted life year averted of $330, suggesting that active case finding was highly cost-effective.

Cost-effectiveness of audiometric screening of first-year preparatory pupils in Dhofar region, Oman
Aasham, T.; Khand ekar, R.; Khabori, M.; Helmi, S.A. ( 2004 )

Audiometric screening was conducted in Dhofar region to study the magnitude of ear problems and cost-effectiveness of screening first-year preparatory-school children in Oman. None of the 1894 pupils had otitis media with effusion or sensory neuronal hearing loss. Six children [0.32%] had impacted wax, 4 [0.21%] chronic suppurative otitis media and 2 [0.11%] dry perforation of eardrum. In all, 14 children [0.74%] with suspected hearing impairment were referred to a specialist but only 2 attended. Physicians and nurses spent 8-10 minutes for ear examination per child for a yield of less than 1%. The screening expenditure was US$ 5 per pupil. As the prevalence of serious ear conditions was low, we conclude that exp and ing the audiometric screening of schoolchildren to first-year preparatory pupils is not cost-effective

Cost-effectiveness of cataract surgery in a public health eye care programme in Nepal / E. Marseille
Marseille, E ( 1996 )
Cost-effectiveness of community health workers in tuberculosis control in Bangladesh / Akramul Islam ... [et al.]
Islam, Akramul; Wakai, Susumu; Ishikawa, Nobukatsu; Chowdhury, A. K. M. N; Vaughan, J. Patrick ( 2002 )
Cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya
Witter, Sophie; Dieleman, Marjolein; Gama, Elvis; Kok, Maryse; Squires, Neil; Ahmed, Rukhsana; Datiko, Daniel; Vaughan, Kelsey; Suraratdecha, Chutima; McPake, Barbara; Kielmann, Karina; Otiso, Lillian; Edoka, Ijeoma; Cometto, Giorgio; Taegtmeyer, Miriam ( 2015-08-03 )

To assess the cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya.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.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.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.

Cost-effectiveness of competing diagnostic-therapeutic strategies for visceral leishmaniasis / M. Boelaert ... [et al.]
Boelaert, M; Lynen, L; Desjeux, P; Stuyft, P. Van der ( 1999 )
Cost-effectiveness of different strategies to monitor adults on antiretroviral treatment: a combined analysis of three mathematical models
Nucifora, Kimberly A; Revill, Paul; Vizcaya, Luisa Salazar; Blaser, Nello; Walker, Simon; Welte, Alex; Ciaranello, Andrea; Keebler, Daniel; Phillips, Andrew; Cambiano, Valentina; Gray, Richard; Easterbrook, Philippa; Keiser, Olivia; Menzies, Nicolas A; Estill, Janne; Hill, Andrew; Hirnschall, Gottfried; Hallett, Timothy B; Kessler, Jason; Braithwaite, Scott; Doherty, Meg; Borquez, Annick ( 2013-12-10 )

BACKGROUND: WHO's 2013 revisions to its Consolidated Guidelines on antiretroviral drugs recommend routine viral load monitoring, rather than clinical or immunological monitoring, as the preferred monitoring approach on the basis of clinical evidence. However, HIV programmes in resource-limited settings require guidance on the most cost-effective use of resources in view of other competing priorities such as expansion of antiretroviral therapy coverage. We assessed the cost-effectiveness of alternative patient monitoring strategies. METHODS: We evaluated a range of monitoring strategies, including clinical, CD4 cell count, and viral load monitoring, alone and together, at different frequencies and with different criteria for switching to second-line therapies. We used three independently constructed and validated models simultaneously. We estimated costs on the basis of resource use projected in the models and associated unit costs; we quantified impact as disability-adjusted life years (DALYs) averted. We compared alternatives using incremental cost-effectiveness analysis. FINDINGS: All models show that clinical monitoring delivers significant benefit compared with a hypothetical baseline scenario with no monitoring or switching. Regular CD4 cell count monitoring confers a benefit over clinical monitoring alone, at an incremental cost that makes it affordable in more settings than viral load monitoring, which is currently more expensive. Viral load monitoring without CD4 cell count every 6-12 months provides the greatest reductions in morbidity and mortality, but incurs a high cost per DALY averted, resulting in lost opportunities to generate health gains if implemented instead of increasing antiretroviral therapy coverage or expanding antiretroviral therapy eligibility. INTERPRETATION: The priority for HIV programmes should be to expand antiretroviral therapy coverage, firstly at CD4 cell count lower than 350 cells per μL, and then at a CD4 cell count lower than 500 cells per μL, using lower-cost clinical or CD4 monitoring. At current costs, viral load monitoring should be considered only after high antiretroviral therapy coverage has been achieved. Point-of-care technologies and other factors reducing costs might make viral load monitoring more affordable in future. FUNDING: Bill & Melinda Gates Foundation, WHO.

Cost-effectiveness of environmental management for vector control in resource development projects
Bos, R ( 1991-01-01 )

Vector control methods are traditionally divided in chemical, biological and environmental management approaches, and this distinction also reflected in certain financial and economic aspects. This is particularly true for environmental modification, usually engineering or other structural works. It is highly capital intensive, as opposed to chemical and biological control which require recurrent expenditures, and discount rates are therefore a prominent consideration in deciding for one or the other approach. Environmental manipulation requires recurrent action, but can often be carried out with the community participation, which raises the issue of opportunity costs. The incorporation of environmental management in resource projects is generally impeded by economic considerations. The Internal Rate of Return continues to be a crucial criterion for funding agencies and development banks to support new projects; at the same time Governments of debt-riden countries in the Third World will do their best to avoid additional loans on such frills as environmental and health safeguards. Two approaches can be recommended to nevertheless ensure the incorporation of environmental management measures in resource projects in an affordable way. First, there are several examples of cases where environmental management measures either have a dual benefit (increasing both agricultural production and reducing vector-borne disease transmission) or can be implemented at zero costs. Second, the additional costs involved in structural modifications can be separated from the project development costs considered in the calculations of the Internal Rate of Return, and financial support can be sought from bilateral technical cooperation agencies particularly interested in environmental and health issues. There is a dearth of information in the cost-effectiveness of alternative vector control strategies in the developing country context. The process of integrating vector control in the general health services will make it even more difficult to gain a clear insight in the matter.

Cost-effectiveness of environmental management for vector control in resource development projects / R. Bos
Bos, R ( 1991 )
Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study
Brisson, Marc; Hutubessy, Raymond; Jit, Mark; Portnoy, Allison ( 2014-06-09 )

BACKGROUND: Introduction of human papillomavirus (HPV) vaccination in settings with the highest burden of HPV is not universal, partly because of the absence of quantitative estimates of country-specific effects on health and economic costs. We aimed to develop and validate a simple generic model of such effects that could be used and understood in a range of settings with little external support. METHODS: We developed the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model to assess cost-effectiveness and health effects of vaccination of girls against HPV before sexual debut in terms of burden of cervical cancer and mortality. PRIME models incidence according to proposed vaccine efficacy against HPV 16/18, vaccine coverage, cervical cancer incidence and mortality, and HPV type distribution. It assumes lifelong vaccine protection and no changes to other screening programmes or vaccine uptake. We validated PRIME against existing reports of HPV vaccination cost-effectiveness, projected outcomes for 179 countries (assuming full vaccination of 12-year-old girls), and outcomes for 71 phase 2 GAVI-eligible countries (using vaccine uptake data from the GAVI Alliance). We assessed differences between countries in terms of cost-effectiveness and health effects. FINDINGS: In validation, PRIME reproduced cost-effectiveness conclusions for 24 of 26 countries from 17 published studies, and for all 72 countries in a published study of GAVI-eligible countries. Vaccination of a cohort of 58 million 12-year-old girls in 179 countries prevented 690,000 cases of cervical cancer and 420,000 deaths during their lifetime (mostly in low-income or middle-income countries), at a net cost of US$4 billion. HPV vaccination was very cost effective (with every disability-adjusted life-year averted costing less than the gross domestic product per head) in 156 (87%) of 179 countries. Introduction of the vaccine in countries without national HPV vaccination at present would prevent substantially more cases of cervical cancer than in countries with such programmes, although the disparity has narrowed since 2012. If 71 phase 2 GAVI-eligible countries adopt vaccination according to forecasts, then in 2070 GAVI Alliance-funded vaccination could prevent 200,000 cases of cervical cancer and 100,000 deaths in some of the highest-burden countries. INTERPRETATION: Large between-country disparities exist for HPV vaccination, with countries with the most to gain yet to introduce national HPV vaccination. Support from the GAVI Alliance could help to reduce such disparities, but a substantial burden will remain even after presently projected vaccine introductions. FUNDING: WHO.

Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age
Losina, Elena; Wools-Kaloustian, Kara; Doherty, Kathleen; Lindsey, Jane C; Muhe, Lulu; Penazzato, Martina; Freedberg, Kenneth A; Weinstein, Milton C; Ayaya, Samuel; Ciaranello, Andrea L; Kelly, Kathleen; Palumbo, Paul; Essajee, Shaffiq; Walensky, Rochelle P; Harrison, Linda ( 2015-06-01 )

The International Maternal, Pediatric, and Adolescent Clinical Trials P1060 trial demonstrated superior outcomes for HIV-infected children less than 3 years old initiating antiretroviral therapy (ART) with lopinavir/ritonavir compared to nevirapine, but lopinavir/ritonavir is four-fold costlier.We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Pediatric model, with published and P1060 data, to project outcomes under three strategies: no ART; first-line nevirapine (with second-line lopinavir/ritonavir); and first-line lopinavir/ritonavir (second-line nevirapine). The base-case examined South African children initiating ART at age 12 months; sensitivity analyses varied all key model parameters. Outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios [ICERs; dollars/year of life saved ($/YLS)]. We considered interventions with ICERs less than 1× per-capita gross domestic product (South Africa: $7500)/YLS as 'very cost-effective,' interventions with ICERs below 3× gross domestic product/YLS as 'cost-effective,' and interventions leading to longer life expectancy and lower lifetime costs as 'cost-saving'.Projected life expectancy was 2.8 years with no ART. Both ART regimens markedly improved life expectancy and were very cost-effective, compared to no ART. First-line lopinavir/ritonavir led to longer life expectancy (28.8 years) and lower lifetime costs ($41 350/person, from lower second-line costs) than first-line nevirapine (27.6 years, $44 030). First-line lopinavir/ritonavir remained cost-saving or very cost-effective compared to first-line nevirapine unless: liquid lopinavir/ritonavir led to two-fold higher virologic failure rates or 15-fold greater costs than in the base-case, or second-line ART following first-line lopinavir/ritonavir was very ineffective.On the basis of P1060 data, first-line lopinavir/ritonavir leads to longer life expectancy and is cost-saving or very cost-effective compared to first-line nevirapine. This supports WHO guidelines, but increasing access to pediatric ART is critical regardless of the regimen used.

Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence
Guinness, Lorna; Alban, Anita; Creese, Andrew; Floyd, Katherine ( 2002-05-01 )

BACKGROUND: Evidence for cost-effectiveness of interventions for HIV/AIDS in Africa is fragmentary. Cost-effectiveness is, however, highly relevant. African governments face difficult choices in striking the right balance between prevention, treatment, and care, all of which are necessary to deal comprehensively with the epidemic. Reductions in drug prices have raised the priority of treatment, though treatment access is restricted. We assessed the existing cost-effectiveness data and its implications for value-for-money strategies to combat HIV/AIDS in Africa. METHODS: We undertook a systematic review using databases and consultations with experts. We identified over 60 reports that measured both the cost and effectiveness of HIV/AIDS interventions in Africa. 24 studies met our inclusion criteria and were used to calculate standardised estimates of the cost (US$ for year 2000) per HIV infection prevented and per disability-adjusted life-year (DALY) gained for 31 interventions. FINDINGS: Cost-effectiveness varied greatly between interventions. A case of HIV/AIDS can be prevented for $11, and a DALY gained for $1, by selective blood safety measures, and by targeted condom distribution with treatment of sexually transmitted diseases. Single-dose nevirapine and short-course zidovudine for prevention of mother-to-child transmission, voluntary counselling and testing, and tuberculosis treatment, cost under $75 per DALY gained. Other interventions, such as formula feeding for infants, home care programmes, and antiretroviral therapy for adults, cost several thousand dollars per infection prevented, or several hundreds of dollars per DALY gained. INTERPRETATION: A strong economic case exists for prioritisation of preventive interventions and tuberculosis treatment. Where potentially exclusive alternatives exist, cost-effectiveness analysis points to an intervention that offers the best value for money. Cost-effectiveness analysis is an essential component of informed debate about priority setting for HIV/AIDS.

Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review
Fesenfeld, Michaela; Jit, Mark; Hutubessy, Raymond ( 2013-07-03 )

The World Health Organization recommends establishing that human papillomavirus vaccination is cost-effective before vaccine introduction. We searched Pubmed, Embase and the Cochrane Library to 1 April 2012 for economic evaluations of human papillomavirus vaccination in low and middle income countries. We found 25 articles, but almost all low income countries and many middle income countries lacked country-specific studies. Methods, assumptions and consequently results varied widely, even for studies conducted for the same country. Despite the heterogeneity, most studies conclude that vaccination is likely to be cost-effective and possibly even cost saving, particularly in settings without organized cervical screening programmes. However, study uncertainty could be reduced by clarity about vaccine prices and vaccine delivery costs. The review supports extending vaccination to low income settings where vaccine prices are competitive, donor funding is available, cervical cancer burden is high and screening options are limited.

Cost-effectiveness of immunization in Colombia / Andrew L. Creese & Mar'ia Alicia Dom'inguez-Ug'a
Creese, Andrew L; Dom'inguez Ug'a, Mar'ia Alicia ( 1987 )
Cost-effectiveness of iron supplementation and malaria chemoprophylaxis in the prevention of anaemia and malaria among Tanzanian infants / M. Alonso González ... [et al.]
Alonso González, M; Menéndez, C; Font, F; Kahigwa, E; Kimario, J; Mshinda, H; Tanner, M; Bosch-Capblanch, X; Alonso, P. L ( 2000 )
Cost-effectiveness of oral cholera vaccine in a stable refugee population at risk for epidemic cholera and in a population with endemic cholera / J. Murray, D. A. McFarland, and R. J. Waldman
Murray, J; McFarland, D. A; Waldman, Ronald J ( 1998 )
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