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Health economics

Cost and cost-effectiveness evaluations

The Warwick gHAT model has been further expanded to provide the cost and cost-effectiveness of the four intervention strategies (see opposite) in terms of net benefit (cost of interventions vs cost of ill-health/disability/death), which is added to the model. Costs include diagnosis, confirmation, and staging via lumbar puncture, well as the cost of the drug itself and the administration. The research offers a number of different options highlighting the most efficient intervention strategy to achieve elimination by 2030 and the optimal strategy to lower costs.

Data and analysis tool: Projected costs of different intervention strategies and cost-effectiveness for 5 health zones in DRC are available to view online via a data and analysis tool (GUI), providing online access to the vast amount of data and results of this research project in a user-friendly way.

Forthcoming paper: Antillon, M, Huang, C, Crump, RE, Brown, P, Snijders, R, Miaka, EM, Rock, KS, Tediosi, F (2020). Economic evaluation of gHAT elimination campaigns in five distinct transmission settings in DRC [pre-print, not peer reviewed]. Paper summaries:  English,  French

Optimising screening with low and falling case numbersThe cost-effectiveness of active screening strategies. (A) Cost-effectiveness plane showing the total cost of a strategy and the associated total number of DALYs averted from the mean value of the comparator strategy. Mean values for each strategy are shown by the coloured crosses. (B) Cost-effectiveness acceptability curves (CEACs) for each strategy are shown by lines, with the cost-effectiveness acceptability frontier (CEAF) shown by the numbered background colour, which demonstrated the values for the ICER. WTP is shown in 2018 USD on the top and as the W T Pc coefficient on the bottom, where the coefficient is the multiplier of the GDP per capita of the DRC.

With limited numbers of active screening teams and resources, it is important to optimise their activities with the aim of driving towards elimination. With gHAT case numbers decreasing, we investigate how to optimise active screening visits to individual villages in DRC, such that the costs of the screening programmes can be minimised, while continuing to avert disability-adjusted life years. A stochastic gHAT infection model has been implemented across a range of active screening strategies and the net monetary benefit (NMB - cost of interventions vs cost of ill-health/disability/death) of each calculated.

Peer-reviewed paper: Davis, C, Rock, KS, Antillón, M, Miaka, EM, Keeling, MJ (2021). Cost-effectiveness modelling to optimise active screening strategy for gambiense human African trypanosomiasis in endemic areas of the Democratic Republic of Congo. BMC Medicine. Paper summaries:  English, French

Extending a cost-effectiveness framework to account for elimination goalsCost-effectiveness acceptability curves and cost breakdown for Region 1. A) the probability of EOT by 2030 for each strategy. B) The traditional cost-effectiveness acceptability frontiers (CEAFs). C) The total cost for a strategy that reaches elimination with 100% probability and the breakdown between minimum cost strategy, and justifiably additional costs and premium of elimination across willingness to pay to avert DALY values.

Various diseases are earmarked for elimination by the global health community. While the health economic implications of elimination have been discussed before, the combination of uncertainty, cost-effectiveness in terms of cases averted, and elimination in the face of rising per-case costs has not been tackled before.

We propose an approach that considers the tension between the dual objectives of cost-effectiveness and elimination while incorporating uncertainty in these objectives. This framework enables us to compute the additional costs of implementing a strategy which is more likely to achieve elimination beyond what would normally be considered cost-effective - which we call the premium of elimination.

We apply our method to strategies against human African trypanosomiasis in three settings, but this method could be directly applied to simulation-based studies of the cost-effectiveness of other disease elimination efforts. The method yields common metrics of efficiency for stakeholders who have different objectives.

Forthcoming paper: Antillon, M, Huang, C, Rock, K and Tediosi, F (2021). Economic evaluation of disease elimination: an extension to the net-benefit framework and application to human African trypanosomiasis [pre-print, not peer reviewed]. Paper summaries:  English