Cost-Effectiveness Analysis of the Togo Integrated Child Health Campaign - Efficiency Gains By Joint Delivery of Multiple Interventions

Résumé fourni par la source

Virtually all previous empirical cost-effectiveness analyses of disease control interventions have concentrated on the delivery of single interventions, despite the fact that the joint delivery of multiple interventions may elicit large efficiency gains. We here report results of a cost-effectiveness analysis of the Togo Integrated Child Health Campaign carried out in December 2004. This was the first nationwide campaign with combined delivery of measles vaccine and distribution of a long-lasting insecticide treated bednet (LLITN) to each eligible household ? an approach now widely advocated for other countries. Both net and gross cost-effectiveness was measured in terms of cost per LLITN distributed and per vaccination administered, cost per death averted, cost per case averted and cost per DALY averted. The analysis was undertaken from a provider perspective. The total costs of the campaign were estimated at 6.45 million USD. Assuming equal attribution of shared costs between the measles and malaria components of the campaign, 5.38 million USD or 83.5% could be attributed to the malaria component and 1.03 million USD or 16% to the measles component. 1.05 million USD or 16.3% of total campaign costs represent shared expenditure between the malaria and measles components. The gross cost per LLITN distributed reached 5.95 USD. Assuming a constant utilisation of LLITN by the target group over three years, 6,285 malaria deaths could be prevented, as well as 1.2 million malaria cases and 243,472 DALYs. The gross cost per malaria death; per case; and per DALY averted amounted to 856 USD; 4.40 USD; and 22.10 USD, respectively. The net cost-effectiveness per LLITN distributed; death averted; case averted; and DALY averted were estimated at 0.81 USD; 118 USD; 0.61 USD; and 3.00 USD, respectively. The gross cost per measles vaccination administered was calculated at 1.16 USD. The gross costs per measles death and case averted amounted to 224.47 USD and 29.59 USD, respectively. The net cost per measles case averted ranged from 6.59 USD to 26.32 USD depending on the ratio of cases treated as inpatients vs. outpatients. As part of the sensitivity analysis, we varied the attribution of shared costs from a 50%/50% split between the malaria and the measles components to a full attribution of shared costs to either component. Assuming that all shared costs were borne by the measles component, the gross cost-effectiveness ratios per malaria death; case; and DALY averted change from 856; 4.40; and 22.10 USD to 772; 3.96; and 19.93 USD, respectively. If shared costs were borne solely by the malaria component, the gross cost-effectiveness ratios would change to 941; 4.83; and 24.28 USD, respectively. The cost-effectiveness results from this analysis are well within commonly agreed benchmarks set by other malaria prevention studies. Varying transmission levels and the attribution of shared costs have a significant impact on cost-effectiveness ratios. This analysis also suggests that substantial efficiency gains can be achieved through the joint delivery of measles vaccinations and LLITNs by means of a campaign approach.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.