Browsing by Subject "Cost-effectiveness analysis"

Young people living with HIV (YPLWH) constitute a growing proportion of the global population of people living with HIV but have less access to HIV testing, diagnosis, treatment, and face heightened mental health challenges. To address these challenges, targeted mental health and medication adherence interventions have been developed, including in Tanzania, which is home to 6% of the world's YPLWH. This study proposes a mathematical model to estimate the health and economic outcomes of mental health HIV adherence interventions targeting YPLWH in Tanzania.We developed a Markov model to predict the long-term health (Disability-Adjusted Life Years (DALY)) and economic outcomes (Value of a Statistical Life Year (VLSY)) of mental health HIV adherence interventions targeting YPLWH. We parameterized the model using outcomes data from the 2016-2020 Sauti ya Vijana randomized control trial (RCT) conducted in Moshi, Tanzania. Cost data were retrieved from a cost analysis of the same RCT and supplemented with data from published literature. The study is conducted from a health payer’s perspective, and the Willingness-To-Pay (WTP) per DALY averted was set to the 2021 Tanzanian GDP per capita (USD 1099.3). Costs and outcomes were modeled for ten years and discounted at an annual rate of 3%. The findings suggest that the Sauti ya Vijana intervention modeled in this study is cost-effective at a WTP of USD 1099.3. The Incremental cost-effectiveness ratio for the intervention compared to the standard of care was USD 637.06 per DALY averted at a 3% discount rate. The benefit-to-cost ratio of the intervention was USD 26.54 in economic productivity for the intervention arm for every dollar spent on the intervention, and the net economic productivity benefit was USD 17,174.74 over a decade. Mental health adherence interventions hold the promise of improving health outcomes amongst YPLWH. The mathematical model developed in this study is a valuable decision-making tool for policymakers regarding mental health adherence interventions targeting YPLWH in Tanzania. The model contributes to the global goal of achieving the UNAIDS 95-95-95 targets for YPLWH.

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Level of evidence

Background:

Interferon Gamma Release Assays (IGRAs) have proven to be potential replacement of tuberculin skin test (TST) in screening and diagnosing tuberculosis as shown by previous health economic studies. Given that these studies all center on pulmonary tuberculosis, we sought to examine the cost-effectiveness of IGRAs, specifically QFT-IT, as a diagnostic test for intraocular tuberculosis among uveitis patients in Singapore.

Method:

A decision tree was constructed to evaluate the cost-effectiveness of the QFT-IT for diagnosing intraocular tuberculosis among uveitis patients over a 30-year horizon. The input data were based on a cohort of 102 patients who presented with symptoms of uveitis and underwent relevant treatment and follow-up visits from 2009 to 2010 at Singapore National Eye Center (SNEC). By calculating their incremental cost-effectiveness ratio, we compared the cost-effectiveness of three strategies: TST alone, QFT-IT alone and TST followed by QFT-IT as a confirmatory test.

Results:

Our results show that in cost terms alone, QFT-IT alone strategy is the most expensive one (889 SGD per person), followed by TST alone (850 SGD per person) and finally the dual strategy (789 SGD per person). While examining effectiveness alone, TST alone strategy is the most effective one that helps gain 17.4923 quality-adjusted life years (QALYs) followed by QFT-IT alone and the dual strategy. Using the conventional willingness to pay of 50,000 USD/QALY (63000 SGD/QALY), having an incremental cost-effectiveness ratio of 1644 SGD/QALY demonstrates that TST alone strategy is the best choice to screen ocular TB in Singapore.

Conclusion:

Given the local ocular tuberculosis prevalence and key assumptions made in the analysis model, the TST alone strategy is recommended to diagnose intraocular TB among uveitis patients in Singapore.

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Methods

Results

Conclusions

Influenza causes an estimated 3 to 5 million cases of severe illness annually, along with substantial morbidity and mortality, particularly among low and middle-income countries (LMICs). The most effective way to decrease the burden of influenza is vaccination. Currently, Sri Lanka has no influenza vaccination policies and does not offer vaccination within the public healthcare sector. Therefore, a cost-effectiveness analysis of influenza vaccine implementation for the Sri Lankan population was performed. A static Markov model that did not account for transmission dynamics was used for this study. The model followed a theoretical cohort of Sri Lankans from all ages through two potential scenarios: universal influenza vaccination and no influenza vaccination across twelve-monthly cycles. Cost-effectiveness was analyzed using a governmental perspective at the national level. Costs for the study were broken down into three categories: direct, indirect, and vaccine costs. All costs were identified from previous literature for the local context. Vaccine efficacy was expressed as a range (48% to 72%) identified from a previous meta-analysis investigating similar settings. One model arm was considered cost-effective if the ICER was below a three-fold gross domestic product (GDP) per capita per DALY averted limit and highly cost-effective if below a one-fold GDP per capita per DALY averted limit. Utilizing TreeAge Pro software, we conducted both probabilistic sensitivity analyses and one-way sensitivity analyses for all model variables. The vaccination model arm reduced all influenza outcomes by approximately 60% (170,283 episodes, 3,167 hospitalizations, and 152 deaths) compared to no vaccination. By implementing vaccination earlier in the year, this reduction in the influenza disease burden was maximized. Vaccination was considered cost-effective compared to no vaccination, with a base case incremental cost-effectiveness ratio (ICER) estimated at Rs. 968,071.45 /DALY (5,418.62 USD/DALY). Sensitivity analysis identified that the ICER was sensitive to implementation month, monthly probability of contracting influenza, cost of vaccination, and years of life disabled. Due to only considering a one-year period, the implementation month had the most substantial effect on the ICER because no potential rollover effects of vaccination could be seen for the later implementation months. Probabilistic sensitivity analyses were performed on all variables, and there was a 99% probability that vaccination was cost-effective below a WTP threshold of 1,157,047.92 Rs/DALY (6,476.38 USD/DALY). No value for a variable within our estimated ranges resulted in ICERs above the WTP threshold of Rs. 2,066,157 (USD 11,556) per DALY averted. In conclusion, vaccination was considered cost-effective when compared to the implementation of no vaccine. However, due to a lack of national data, large-scale national studies are needed to determine better the influenza disease burden, at-risk population, and implementation cost.