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Cost effectiveness and resource allocation of Plasmodium falciparum malaria control in Myanmar: a modelling analysis of bed nets and community health workers.

Drake TL, Kyaw SS, Kyaw MP, Smithuis FM, Day NP, White LJ, Lubell Y - Malar. J. (2015)

Bottom Line: Standard cost effectiveness analysis is then extended via a spatially explicit resource allocation model.Modelled resource allocation scenarios highlight that in this case there is no "one size fits all" cost effectiveness result.Health gains will be maximized by effective targeting of both interventions.

View Article: PubMed Central - PubMed

Affiliation: Mahidol-Oxford Tropical Medicine Research Unit, 420/6 Rajvithi Rd, Bangkok, 10400, Thailand. Tom.D@tropmedres.ac.

ABSTRACT

Background: Funding for malaria control and elimination in Myanmar has increased markedly in recent years. While there are various malaria control tools currently available, two interventions receive the majority of malaria control funding in Myanmar: (1) insecticide-treated bed nets and (2) early diagnosis and treatment through malaria community health workers. This study aims to provide practical recommendations on how to maximize impact from investment in these interventions.

Methods: A simple decision tree is used to model intervention costs and effects in terms of years of life lost. The evaluation is from the perspective of the service provider and costs and effects are calculated in line with standard methodology. Sensitivity and scenario analysis are undertaken to identify key drivers of cost effectiveness. Standard cost effectiveness analysis is then extended via a spatially explicit resource allocation model.

Findings: Community health workers have the potential for high impact on malaria, particularly where there are few alternatives to access malaria treatment, but are relatively costly. Insecticide-treated bed nets are comparatively inexpensive and modestly effective in Myanmar, representing a low risk but modest return intervention. Unlike some healthcare interventions, bed nets and community health workers are not mutually exclusive nor are they necessarily at their most efficient when universally applied. Modelled resource allocation scenarios highlight that in this case there is no "one size fits all" cost effectiveness result. Health gains will be maximized by effective targeting of both interventions.

No MeSH data available.


Related in: MedlinePlus

Change in CHW cost effectiveness: univariate sensitivity analysis of all relevant parameters
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Fig3: Change in CHW cost effectiveness: univariate sensitivity analysis of all relevant parameters

Mentions: Univariate sensitivity analysis was conducted for the cost effectiveness of CHW (Fig. 3) and bed nets (Fig. 4) using the wide uncertainty ranges in Table 1. The key determinants of cost effectiveness for CHW are baseline access to treatment with an ACT and the likelihood that a person with malaria seeks treatment from the CHW. In reality these two factors may be related; low baseline access to treatment might be expected to increase treatment seeking at a CHW. Univariate sensitivity analysis treats these values as independent. The key determinants of bed net cost effectiveness are the untreated malaria mortality risk and the protective effect of the net. Changes in malaria incidence and mortality affect the magnitude of effects substantially but proportionally for all intervention options, and therefore do not affect intervention comparison.Fig. 3


Cost effectiveness and resource allocation of Plasmodium falciparum malaria control in Myanmar: a modelling analysis of bed nets and community health workers.

Drake TL, Kyaw SS, Kyaw MP, Smithuis FM, Day NP, White LJ, Lubell Y - Malar. J. (2015)

Change in CHW cost effectiveness: univariate sensitivity analysis of all relevant parameters
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4587798&req=5

Fig3: Change in CHW cost effectiveness: univariate sensitivity analysis of all relevant parameters
Mentions: Univariate sensitivity analysis was conducted for the cost effectiveness of CHW (Fig. 3) and bed nets (Fig. 4) using the wide uncertainty ranges in Table 1. The key determinants of cost effectiveness for CHW are baseline access to treatment with an ACT and the likelihood that a person with malaria seeks treatment from the CHW. In reality these two factors may be related; low baseline access to treatment might be expected to increase treatment seeking at a CHW. Univariate sensitivity analysis treats these values as independent. The key determinants of bed net cost effectiveness are the untreated malaria mortality risk and the protective effect of the net. Changes in malaria incidence and mortality affect the magnitude of effects substantially but proportionally for all intervention options, and therefore do not affect intervention comparison.Fig. 3

Bottom Line: Standard cost effectiveness analysis is then extended via a spatially explicit resource allocation model.Modelled resource allocation scenarios highlight that in this case there is no "one size fits all" cost effectiveness result.Health gains will be maximized by effective targeting of both interventions.

View Article: PubMed Central - PubMed

Affiliation: Mahidol-Oxford Tropical Medicine Research Unit, 420/6 Rajvithi Rd, Bangkok, 10400, Thailand. Tom.D@tropmedres.ac.

ABSTRACT

Background: Funding for malaria control and elimination in Myanmar has increased markedly in recent years. While there are various malaria control tools currently available, two interventions receive the majority of malaria control funding in Myanmar: (1) insecticide-treated bed nets and (2) early diagnosis and treatment through malaria community health workers. This study aims to provide practical recommendations on how to maximize impact from investment in these interventions.

Methods: A simple decision tree is used to model intervention costs and effects in terms of years of life lost. The evaluation is from the perspective of the service provider and costs and effects are calculated in line with standard methodology. Sensitivity and scenario analysis are undertaken to identify key drivers of cost effectiveness. Standard cost effectiveness analysis is then extended via a spatially explicit resource allocation model.

Findings: Community health workers have the potential for high impact on malaria, particularly where there are few alternatives to access malaria treatment, but are relatively costly. Insecticide-treated bed nets are comparatively inexpensive and modestly effective in Myanmar, representing a low risk but modest return intervention. Unlike some healthcare interventions, bed nets and community health workers are not mutually exclusive nor are they necessarily at their most efficient when universally applied. Modelled resource allocation scenarios highlight that in this case there is no "one size fits all" cost effectiveness result. Health gains will be maximized by effective targeting of both interventions.

No MeSH data available.


Related in: MedlinePlus