Limits...
Bioeconomic analysis of child-targeted subsidies for artemisinin combination therapies: a cost-effectiveness analysis.

Klein EY, Smith DL, Cohen JM, Laxminarayan R - J R Soc Interface (2015)

Bottom Line: Because the vast majority of malaria deaths occur in children, targeting children could potentially improve the cost-effectiveness of the subsidy, though it would avert significantly fewer deaths.However, the benefits of a child-targeted subsidy (i.e. deaths averted) are eroded as leakage (i.e. older individuals taking young child-targeted doses) increases, with few of the benefits of a universal subsidy gained (i.e. reductions in overall prevalence).Although potentially more cost-effective, a child-targeted subsidy must contain measures to reduce the possibility of leakage.

View Article: PubMed Central - PubMed

Affiliation: Center for Disease Dynamics, Economics and Policy, Washington, DC, USA Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.

ABSTRACT
The Affordable Medicines Facility for malaria (AMFm) was conceived as a global market-based mechanism to increase access to effective malaria treatment and prolong effectiveness of artemisinin. Although results from a pilot implementation suggested that the subsidy was effective in increasing access to high-quality artemisinin combination therapies (ACTs), the Global Fund has converted AMFm into a country-driven mechanism whereby individual countries could choose to fund the subsidy from within their country envelopes. Because the initial costs of the subsidy in the pilot countries was higher than expected, countries are also exploring alternatives to a universal subsidy, such as subsidizing only child doses. We examined the incremental cost-effectiveness of a child-targeted policy using an age-structured bioeconomic model of malaria from the provider perspective. Because the vast majority of malaria deaths occur in children, targeting children could potentially improve the cost-effectiveness of the subsidy, though it would avert significantly fewer deaths. However, the benefits of a child-targeted subsidy (i.e. deaths averted) are eroded as leakage (i.e. older individuals taking young child-targeted doses) increases, with few of the benefits of a universal subsidy gained (i.e. reductions in overall prevalence). Although potentially more cost-effective, a child-targeted subsidy must contain measures to reduce the possibility of leakage.

No MeSH data available.


Related in: MedlinePlus

Incremental cost-effectiveness of universal subsidy compared with age-targeted subsidy, low elasticity. Although an untargeted subsidy is fairly cost-effective compared with the scenario of no subsidy, the incremental cost-effectiveness of a universal subsidy compared with the targeted subsidy, even with leakage, is quite large in most countries because of the paucity of malaria deaths in older age groups. This is true both for (a) deaths averted and (b) DALYs averted. Results are mean and 80% confidence interval for a bootstrap percentile method [45] of the sensitivity analysis results. No confidence intervals are shown for Madagascar because ICER values are negative.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4590492&req=5

RSIF20141356F4: Incremental cost-effectiveness of universal subsidy compared with age-targeted subsidy, low elasticity. Although an untargeted subsidy is fairly cost-effective compared with the scenario of no subsidy, the incremental cost-effectiveness of a universal subsidy compared with the targeted subsidy, even with leakage, is quite large in most countries because of the paucity of malaria deaths in older age groups. This is true both for (a) deaths averted and (b) DALYs averted. Results are mean and 80% confidence interval for a bootstrap percentile method [45] of the sensitivity analysis results. No confidence intervals are shown for Madagascar because ICER values are negative.

Mentions: Leakage also decreases the cost-effectiveness of the subsidy (table 3; electronic supplementary material, table S3), though a child-targeted subsidy costs significantly less than a universal subsidy, even with significant leakage. However, because of the relative paucity of malaria deaths in individuals 5 years and older, the incremental cost-effectiveness of moving from a child-targeted subsidy to a universal subsidy is high, unless a large amount of leakage is assumed (figure 4). We also found that over the time period of the study, resistance did not greatly impact the results, even when individuals 5 years and older were assumed to underdose more than under our baseline assumptions (electronic supplementary material, figure S2). Presumably a longer time frame would increase the possibility that such actions would affect resistance. Though the cost-effectiveness values calculated are similar in magnitude to prior estimates [12], great variation was observed between countries driven by differences in the death rates between countries, the effect of the subsidy on demand, and the cost of the subsidy (electronic supplementary material, table S4).TableĀ 3.


Bioeconomic analysis of child-targeted subsidies for artemisinin combination therapies: a cost-effectiveness analysis.

Klein EY, Smith DL, Cohen JM, Laxminarayan R - J R Soc Interface (2015)

Incremental cost-effectiveness of universal subsidy compared with age-targeted subsidy, low elasticity. Although an untargeted subsidy is fairly cost-effective compared with the scenario of no subsidy, the incremental cost-effectiveness of a universal subsidy compared with the targeted subsidy, even with leakage, is quite large in most countries because of the paucity of malaria deaths in older age groups. This is true both for (a) deaths averted and (b) DALYs averted. Results are mean and 80% confidence interval for a bootstrap percentile method [45] of the sensitivity analysis results. No confidence intervals are shown for Madagascar because ICER values are negative.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4590492&req=5

RSIF20141356F4: Incremental cost-effectiveness of universal subsidy compared with age-targeted subsidy, low elasticity. Although an untargeted subsidy is fairly cost-effective compared with the scenario of no subsidy, the incremental cost-effectiveness of a universal subsidy compared with the targeted subsidy, even with leakage, is quite large in most countries because of the paucity of malaria deaths in older age groups. This is true both for (a) deaths averted and (b) DALYs averted. Results are mean and 80% confidence interval for a bootstrap percentile method [45] of the sensitivity analysis results. No confidence intervals are shown for Madagascar because ICER values are negative.
Mentions: Leakage also decreases the cost-effectiveness of the subsidy (table 3; electronic supplementary material, table S3), though a child-targeted subsidy costs significantly less than a universal subsidy, even with significant leakage. However, because of the relative paucity of malaria deaths in individuals 5 years and older, the incremental cost-effectiveness of moving from a child-targeted subsidy to a universal subsidy is high, unless a large amount of leakage is assumed (figure 4). We also found that over the time period of the study, resistance did not greatly impact the results, even when individuals 5 years and older were assumed to underdose more than under our baseline assumptions (electronic supplementary material, figure S2). Presumably a longer time frame would increase the possibility that such actions would affect resistance. Though the cost-effectiveness values calculated are similar in magnitude to prior estimates [12], great variation was observed between countries driven by differences in the death rates between countries, the effect of the subsidy on demand, and the cost of the subsidy (electronic supplementary material, table S4).TableĀ 3.

Bottom Line: Because the vast majority of malaria deaths occur in children, targeting children could potentially improve the cost-effectiveness of the subsidy, though it would avert significantly fewer deaths.However, the benefits of a child-targeted subsidy (i.e. deaths averted) are eroded as leakage (i.e. older individuals taking young child-targeted doses) increases, with few of the benefits of a universal subsidy gained (i.e. reductions in overall prevalence).Although potentially more cost-effective, a child-targeted subsidy must contain measures to reduce the possibility of leakage.

View Article: PubMed Central - PubMed

Affiliation: Center for Disease Dynamics, Economics and Policy, Washington, DC, USA Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.

ABSTRACT
The Affordable Medicines Facility for malaria (AMFm) was conceived as a global market-based mechanism to increase access to effective malaria treatment and prolong effectiveness of artemisinin. Although results from a pilot implementation suggested that the subsidy was effective in increasing access to high-quality artemisinin combination therapies (ACTs), the Global Fund has converted AMFm into a country-driven mechanism whereby individual countries could choose to fund the subsidy from within their country envelopes. Because the initial costs of the subsidy in the pilot countries was higher than expected, countries are also exploring alternatives to a universal subsidy, such as subsidizing only child doses. We examined the incremental cost-effectiveness of a child-targeted policy using an age-structured bioeconomic model of malaria from the provider perspective. Because the vast majority of malaria deaths occur in children, targeting children could potentially improve the cost-effectiveness of the subsidy, though it would avert significantly fewer deaths. However, the benefits of a child-targeted subsidy (i.e. deaths averted) are eroded as leakage (i.e. older individuals taking young child-targeted doses) increases, with few of the benefits of a universal subsidy gained (i.e. reductions in overall prevalence). Although potentially more cost-effective, a child-targeted subsidy must contain measures to reduce the possibility of leakage.

No MeSH data available.


Related in: MedlinePlus