Assessing Hygiene Cost-Effectiveness

This paper introduces "hygiene effectiveness levels" as a tool for standardized analysis of costs and outcomes of hygiene promotion interventions. At the time of publication, the framework was being tested in WASHCost focus countries

Cost-effectiveness analysis of malaria rapid diagnostic tests for appropriate treatment of malaria at the community level in Uganda.

In Sub-Saharan Africa, malaria remains a major cause of morbidity and mortality among children under 5, due to lack of access to prompt and appropriate diagnosis and treatment. Many countries have scaled-up community health workers (CHWs) as a strategy towards improving access. The present study was a cost-effectiveness analysis of the introduction of malaria rapid diagnostic tests (mRDTs) performed by CHWs in two areas of moderate-to-high and low malaria transmission in rural Uganda. CHWs were trained to perform mRDTs and treat children with artemisinin-based combination therapy (ACT) in the intervention arm while CHWs offered treatment based on presumptive diagnosis in the control arm. Data on the proportion of children with fever 'appropriately treated for malaria with ACT' were captured from a randomised trial. Health sector costs included: training of CHWs, community sensitisation, supervision, allowances for CHWs and provision of mRDTs and ACTs. The opportunity costs of time utilised by CHWs were estimated based on self-reporting. Household costs of subsequent treatment-seeking at public health centres and private health providers were captured in a sample of households. mRDTs performed by CHWs was associated with large improvements in appropriate treatment of malaria in both transmission settings. This resulted in low incremental costs for the health sector at US$3.0 per appropriately treated child in the moderate-to-high transmission area. Higher incremental costs at US$13.3 were found in the low transmission area due to lower utilisation of CHW services and higher programme costs. Incremental costs from a societal perspective were marginally higher. The use of mRDTs by CHWs improved the targeting of ACTs to children with malaria and was likely to be considered a cost-effective intervention compared to a presumptive diagnosis in the moderate-to-high transmission area. In contrast to this, in the low transmission area with low attendance, RDT use by CHWs was not a low cost intervention

Cost-effectiveness of Xpert MTB/RIF for tuberculosis diagnosis in South Africa: a real-world cost analysis and economic evaluation

Background In 2010 a new diagnostic test for tuberculosis, Xpert MTB/RIF, received a conditional programmatic recommendation from WHO. Several model-based economic evaluations predicted that Xpert would be cost-effective across sub-Saharan Africa. We investigated the cost-effectiveness of Xpert in the real world during national roll-out in South Africa. Methods For this real-world cost analysis and economic evaluation, we applied extensive primary cost and patient event data from the XTEND study, a pragmatic trial examining Xpert introduction for people investigated for tuberculosis in 40 primary health facilities (20 clusters) in South Africa enrolled between June 8, and Nov 16, 2012, to estimate the costs and cost per disability-adjusted life-year averted of introducing Xpert as the initial diagnostic test for tuberculosis, compared with sputum smear microscopy (the standard of care). Findings The mean total cost per study participant for tuberculosis investigation and treatment was US$312·58 (95$298·58 (246·35–350·82) in the microscopy group. The mean health service (provider) cost per study participant was $168·79 (149·16–188·42) for the Xpert group and$160·46 (143·24–177·68) for the microscopy group of the study. Considering uncertainty in both cost and effect using a wide range of willingness to pay thresholds, we found less than 3% probability that Xpert introduction improved the costeffectiveness of tuberculosis diagnostics. Interpretation After analysing extensive primary data collection during roll-out, we found that Xpert introduction in South Africa was cost-neutral, but found no evidence that Xpert improved the cost-effectiveness of tuberculosis diagnosis. Our study highlights the importance of considering implementation constraints, when predicting and evaluating the cost-effectiveness of new tuberculosis diagnostics in South Africa

A preliminary cost-effectiveness analysis of denitrifying bioreactors in the Lower Burdekin

A cost-effectiveness (CE) analysis was undertaken to assess the cost per kilogram of nitrate-nitrogen ($/kg N) removed by denitrifying bioreactor beds in a sugarcane production system in Queensland. The preliminary analysis evaluates the CE of a 34m3 bioreactor bed trialled on a sugarcane farm in the lower Burdekin delta district, conducted as part of the Bioreactors for GBR Project, funded through the Queensland Reef Water Quality Program. The aim of the project was to investigate the nitrate removal performance of bioreactor beds receiving run-off from sugarcane farms in the lower Burdekin. In addition, the CE of a hypothetical 100m3 bioreactor scenario is also explored. The project trialled and monitored three bioreactor beds in the lower Burdekin. Of the three trials, one produced a more comprehensive dataset compared to the others that had experienced significant blockages during the trial period. Data from this trial was therefore utilised in the CE analysis. High-frequency water quality monitoring was undertaken over 12 months (May 2019 - April 2020) with nitrate concentration, woodchip saturation and water flow analysed to enable calculation of the nitrogen removal rate (NRR)

Costs, outcomes, and cost-effectiveness of ovc interventions

This item is archived in the repository for materials published for the USAID supported Orphans and Vulnerable Children Comprehensive Action Research Project (OVC-CARE) at the Boston University Center for Global Health and Development.More than 1 out of every 10 children in sub-Saharan Africa and 1 out of 15 in Asia are orphans. A significant proportion of these children in sub-Saharan Africa were orphaned because one or both parents died from AIDS. Large numbers of other children are vulnerable to becoming orphans because one or both parents are HIV-infected. In response to the needs to children who are orphaned or made more vulnerable because of HIV/AIDS, the U.S. government through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) spent about $1 billion during 2006-2008 on activities to improve the wellbeing of orphans and vulnerable children (OVC). Through the Reauthorization Act of 2008 [1], significant sums will continue to be allocated to OVC programs between 2009 and 2013. Given the past and continuing magnitude of the U.S. public’s investment in PEPFAR-funded OVC programs, combined with several years of implementation experience, this report reviews existing literature addressing the costs, the impacts/outcomes, and cost-effectiveness of OVC programs/interventions.The USAID | Project SEARCH, Orphans and Vulnerable Children Comprehensive Action Research (OVC-CARE) Task Order, is funded by the U.S. Agency for International Development under Contract No. GHH-I-00-07-00023-00, beginning August 1, 2008. OVC-CARE Task Order is implemented by Boston University. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the funding agency

Cost-Effectiveness Thresholds in Global Health: Taking a Multisectoral Perspective.

Good health is a function of a range of biological, environmental, behavioral, and social factors. The consumption of quality health care services is therefore only a part of how good health is produced. Although few would argue with this, the economic framework used to allocate resources to optimize population health is applied in a way that constrains the analyst and the decision maker to health care services. This approach risks missing two critical issues: 1) multiple sectors contribute to health gain and 2) the goods and services produced by the health sector can have multiple benefits besides health. We illustrate how present cost-effectiveness thresholds could result in health losses, particularly when considering health-producing interventions in other sectors or public health interventions with multisectoral outcomes. We then propose a potentially more optimal second best approach, the so-called cofinancing approach, in which the health payer could redistribute part of its budget to other sectors, where specific nonhealth interventions achieved a health gain more efficiently than the health sector's marginal productivity (opportunity cost). Likewise, other sectors would determine how much to contribute toward such an intervention, given the current marginal productivity of their budgets. Further research is certainly required to test and validate different measurement approaches and to assess the efficiency gains from cofinancing after deducting the transaction costs that would come with such cross-sectoral coordination

Electrochemical Journals, AIP's Scitation, Cost-Effectiveness

A review of the relative subscription costs, page & article counts of Electrochemical Society journals compared with commercial counterparts. A description of the AIP's Scitation database. The relative cost-effectiveness (normalized cost/article/Impact Factor) of society and commercial journals related to electrochemistry

Cost-Effectiveness of Stronger Woodframe Buildings

We examine the cost-effectiveness of improvements in woodframe buildings. These include retrofits, redesign measures, and improved quality in 19 hypothetical woodframe dwellings. We estimated cost-effectiveness for each improvement and each zip code in California. The dwellings were designed under the CUREE-Caltech Woodframe Project. Costs and seismic vulnerability were determined on a component-by-component basis using the Assembly Based Vulnerability method, within a nonlinear time-history structural-analysis framework and using full-size test specimen data. Probabilistic site hazard was calculated by zip code, considering site soil classification, and integrated with vulnerability to determine expected annualized repair cost. The approach provides insight into uncertainty of loss at varying shaking levels. We calculated present value of benefit to determine cost-effectiveness in terms of benefit-cost ratio (BCR). We find that one retrofit exhibits BCRs as high as 8, and is in excess of 1 in half of California zip codes. Four retrofit or redesign measures are cost-effective in at least some locations. Higher quality is estimated to save thousands of dollars per house. Results are illustrated by maps for the Los Angeles and San Francisco regions and are available for every zip code in California

Analysis of uncertainty in health care cost-effectiveness studies: an introduction to statistical issues and methods

Cost-effectiveness analysis is now an integral part of health technology assessment and addresses the question of whether a new treatment or other health care program offers good value for money. In this paper we introduce the basic framework for decision making with cost-effectiveness data and then review recent developments in statistical methods for analysis of uncertainty when cost-effectiveness estimates are based on observed data from a clinical trial. Although much research has focused on methods for calculating confidence intervals for cost-effectiveness ratios using bootstrapping or Fieller’s method, these calculations can be problematic with a ratio-based statistic where numerator and=or denominator can be zero. We advocate plotting the joint density of cost and effect differences, together with cumulative density plots known as cost-effectiveness acceptability curves (CEACs) to summarize the overall value-for-money of interventions. We also outline the net-benefit formulation of the cost-effectiveness problem and show that it has particular advantages over the standard incremental cost-effectiveness ratio formulation