Maximizing the Impact of Voluntary Medical Male Circumcision for HIV Prevention in Zambia by Targeting High-Risk Men: A Pre/Post Program Evaluation

AIDS and Behavior - A well-documented barrier to voluntary medical male circumcision (VMMC) is financial loss due to the missed opportunity to work while undergoing and recovering from VMMC. We...     

Cost and effectiveness analysis of immunization service delivery support in Andhra Pradesh, India

The immunization service delivery support (ISDS) model was initiated in Andhra Pradesh, India, in November 2003 with the aim of strengthening immunization services through supportive supervision. The ISDS model involves a well-established supervision system built upon the existing health infrastructure. The objectives of this approach are to: (1) identify areas of high performance and those that need improvement, (2) assist staff in identifying and correcting wrong practices, (3) improve staff skills, (4) motivate staff, and (5) initiate corrective actions at appropriate levels through information sharing. An evaluation of cost and effectiveness of ISDS in 16 districts that participated in the programme found that the incremental cost associated with three rounds of supportive supervision visits was approximately US$ 110,630 (US$ 36,877 per round). The performance of health centre and immunization sessions was evaluated using 43- and 28-point checklists, respectively, and demonstrated significant improvement during and following the two-year implementation of ISDS. The average percentage change in health centre performance scores from baseline to the fourth round of evaluation was approximately 36%, and immunization session performance scores increased by an average of 9%. The incremental costs per additional per cent increase in average health centre performance score and per additional per cent increase in average immunization session performance score over the evaluation period were estimated to be US$ 3091 and US$ 12,760, respectively. The incremental cost-effectiveness ratios are relatively sensitive to personnel and travel costs. Integration of ISDS into the Andhra Pradesh immunization system is projected to result in a 39% potential cost savings per round of supervision visit.     

陕西省2005年病毒性脑炎监测结果分析

目的通过对陕西省安康、宝鸡、渭南3个地区病毒性脑炎的监测,了解病毒性脑炎流行病学特征及流行性乙型脑炎（乙脑）发病情况。方法采用ELISA法检测乙脑IgM;由监测医院报告病例,县级疾病预防控制中心进行个案调查。结果398例病例中,乙脑IgM阳性病例76例,占19.10%。在发病7 d内、7 d后采集的血标本、脑脊液标本阳性率分别为26.24%,18.18%和20.59%,其阳性率差异无统计学意义。发病7 d内与7 d后采集的血标本与脑脊液检测结果一致率分别为86.67%和80.00%。病毒性脑炎发病6～9月较高,与乙脑IgM阳性病例时间分布基本一致,11月病毒性脑炎病例出现一个小高峰;病毒性脑炎病例中15岁以下占73.62%,乙脑IgM阳性病例中0～5岁最高占36.84%,其他病毒性脑炎5～10岁组最高占40.68%;乙脑IgM阳性病例中散居儿童和农民占比例较高为71.05%,其他病毒性脑炎学生占比例较高为56.83%;未接种及接种史不详在乙脑IgM阳性病例中占76.31%;出院时转归,乙脑IgM阳性病例和其他病脑治愈比例分别为67.11%,83.23%,病死率分别为9.21%,3.11%。结论乙脑病例在发病7 d内和7 d后采血进行IgM检测对乙脑诊断均有意义。应提高乙脑疫苗接种率,在作好儿童乙脑防治的同时,加强对成人乙脑防控工作。     

Is universal coverage a solution for disparities in health care? Findings from three low-income provinces of Thailand

The policy on universal coverage (UC) of health care has been adopted and implemented incrementally by the government of Thailand since April 2001 with the aim of providing the access to care for the uninsured population. The success of UC, however, depends on how effective its design and implementation arrangements are in reaching population and affecting households' health seeking behavior and abilities to take up benefits of UC. The results from the household survey of 1834 respondents conducted in three low-income provinces (Tak, Sakol Nakorn, Narathiwat) show that the Gold card with exemption scheme was pro-poor while other insurance schemes tended to favor the rich with 2.6% of respondents reported having more than one type of health insurance coverage and 8.9% without health insurance. The insurance status had statistically significant association with health care use, and knowledge on family planning method and sexually transmitted diseases. Additionally, consumer preferences and socioeconomics factors are a key to disparities in health care utilization.     

A cost–effectiveness analysis of Japanese encephalitis vaccine in Cambodia

This study aimed to evaluate the cost and effectiveness of introducing a live, attenuated vaccine (SA 14-14-2) against Japanese encephalitis (JE) into the immunization program. The study demonstrated that SA 14-14-2 immunization is cost–effective in controlling JE in Cambodia compared to no vaccination. Averting one disability-adjusted life year, from a societal perspective, through the introduction of SA 14-14-2 through routine immunization, or a combination of routine immunization plus a campaign targeting children 1–5 or 1–10 years of age, costs US$22, US$34 and US$53, respectively. Sensitivity analyses confirmed that there was a high probability of SA 14-14-2 immunization being cost–effective under conditions of uncertainty.     

Determinants of Thailand household healthcare expenditure: the relevance of permanent resources and other correlates

Several papers in the leading health economics journals modeled the determinants of healthcare expenditure using household survey or family budgets data of developed countries. Past work largely used self‐reported current income as the core determinant, whereas the theoretically correct concept of household resource constraint is permanent or long‐run income (á lá Milton Friedman). This paper strives to rectify the theoretical oversight of using current income by augmenting the model with household asset. Using longitudinal data, we constructed ‘wealth index’ as a distinct covariate to capture the households' tendency to liquidate assets when defraying necessary healthcare liabilities after exhausting cash incomes. (Current income and assets together capture the household expanded resource base). Using 98 632 household observations from Thailand Socio‐Economic Surveys (1994–2000 biennial data cycles) we found, using a double‐hurdle model with dependent errors, that out‐of‐pocket healthcare spending behaves as a technical necessity across income quintiles and household sizes. Pre‐1997 economic shock income elasticities are smaller than the post‐shock estimates across income quintiles for large and small households. Proximity to death, median age, and assets are also among other significant determinants. Our novel findings extend the theoretical consistency of a multi‐level decision model in household healthcare expenditure in the developing Asian country context. Copyright © 2009 John Wiley & Sons, Ltd.     

The private demand for an AIDS vaccine in Thailand

A contingent valuation survey of Thai adults revealed that private demand for a hypothetical AIDS vaccine that is safe, has no side effects, and lasts 10 years, rises with income, the lifetime risk of HIV infection and vaccine efficacy, and declines with vaccine price and respondent's age. Demand for both high (95%) and low (50%) efficacy AIDS vaccines is substantial. Nearly 80% of adults would agree to be vaccinated with a free vaccine. Government will have an important role to ensure that those at highest risk of HIV infection with low incomes have access to the vaccine and to reinforce other safe preventive behavior to prevent reductions in condom use.     

Cost–effectiveness of community-based practitioner programmes in Ethiopia,Indonesia and Kenya

Objective

To assess the cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya.

Methods

Incremental cost–effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value.

Findings

The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective.

Conclusion

Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.