Malaria elimination transmission and costing in the Asia-Pacific: developing an investment case

Background:; The Asia-Pacific region has made significant progress against malaria, reducing cases and deaths by over 50% between 2010 and 2015. These gains have been facilitated in part, by strong political and financial commitment of governments and donors. However, funding gaps and persistent health system challenges threaten further progress. Achieving the regional goal of malaria elimination by 2030 will require an intensification of efforts and a plan for sustainable financing. This article presents an investment case for malaria elimination to facilitate these efforts.; Methods:; A transmission model was developed to project rates of decline of; Plasmodium falciparum; and; Plasmodium vivax; malaria and the output was used to determine the cost of the interventions that would be needed for elimination by 2030. In total, 80 scenarios were modelled under various assumptions of resistance and intervention coverage. The mortality and morbidity averted were estimated and health benefits were monetized by calculating the averted cost to the health system, individual households, and society. The full-income approach was used to estimate the economic impact of lost productivity due to premature death and illness, and a return on investment was computed.; Results; : The study estimated that malaria elimination in the region by 2030 could be achieved at a cost of USD 29.02 billion (range: USD 23.65-36.23 billion) between 2017 and 2030. Elimination would save over 400,000 lives and avert 123 million malaria cases, translating to almost USD 90 billion in economic benefits. Discontinuing vector control interventions and reducing treatment coverage rates to 50% will result in an additional 845 million cases, 3.5 million deaths, and excess costs of USD 7 billion. Malaria elimination provides a 6:1 return on investment.; Conclusion:; This investment case provides compelling evidence for the benefits of continued prioritization of funding for malaria and can be used to develop an advocacy strategy

Alcohol-Related Liver Disease in the US: Projections of Future Burden and Economic Evaluation of Pricing Policies

Alcohol-related liver disease (ALD) is a set of conditions caused by repeated liver injury that results from chronic and excessive alcohol consumption. ALD is a significant cause of morbidity and mortality in the US; it is currently the cause of half of all cirrhosis-related deaths and is the leading indication for liver transplantation. ALD-related mortality rates are increasing in the US, especially among women, certain racial/ethnic minority groups, and young adults, which raises health equity concerns. The burden of ALD is expected to rise as alcohol use and misuse continue to increase in these populations. To advance our understanding of ALD and the potential impact of evidence-based policy interventions in the US, I conducted three studies. In the first study (Chapter 2), I developed a calibrated microsimulation model and projected the future burden of ALD across different subgroups. I estimated that ALD cases and deaths may increase in the US as rates of alcohol misuse rise. I found that average ALD incidence and mortality rates masked stark differences between sociodemographic groups. I also found that groups that have been disproportionately affected by ALD in the past are still likely to bear its health burden in the future. In the second study (Chapter 3), I compared the long-term costs, health benefits, and cost-effectiveness of two pricing policies, namely increases to alcohol excise taxes and minimum unit pricing (MUP). I found that alcohol tax increases and MUP are cost-saving or cost-effective interventions when compared to the status quo. Among all interventions, an MUP that increased the price of the cheapest alcohol by 100% had the highest probability of providing the most value for money, though results were sensitive to parameter uncertainty. In the third and final study (Chapter 4), I applied a distributional cost-effectiveness analysis framework to evaluate the cost-effectiveness and equity impacts of beer and liquor taxes. I leveraged previous estimates of the heterogeneous effects of pricing policies across racial/ethnic and gender groups. I found that a 30% liquor tax increase was the most economically efficient intervention compared to the status quo or to other liquor and beer taxes included in the analysis. However, the 30% liquor tax was associated with the highest health inequality, which is likely outweighed by the total health benefits produced. The studies in dissertation found that that the burden of ALD is expected to increase in the US, and that pricing policies are effective interventions to reverse this trend. However, pricing policies may have heterogeneous effects across subgroups that require further evaluation. This dissertation emphasizes the need to explore the distributional effects of interventions to ensure that they are effective, efficient, and equitable.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/174231/1/antonlv_1.pd