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Marseille E, Jiwani A, Raut A, et al. Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries. BMJ Open. 2014;4(6):e003987doi: 10.1136/bmjopen-2013-003987.
Marseille, E., Jiwani, A., Raut, A., Verguet, S., Walson, J., & Kahn, J. G. (2014). Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries. BMJ open, 4(6), e003987. https://doi.org/10.1136/bmjopen-2013-003987
Marseille, Elliot, et al. "Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries." BMJ open vol. 4,6 (2014): e003987. doi: https://doi.org/10.1136/bmjopen-2013-003987
Marseille E, Jiwani A, Raut A, Verguet S, Walson J, Kahn JG. Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries. BMJ Open. 2014 Jun 26;4(6):e003987. doi: 10.1136/bmjopen-2013-003987. PMID: 24969782; PMCID: PMC4078786.
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BMJ Open. 2014 Jun 26;4(6):e003987. doi: 10.1136/bmjopen-2013-003987.

Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries.

BMJ open

Elliot Marseille, Aliya Jiwani, Abhishek Raut, Stéphane Verguet, Judd Walson, James G Kahn

Affiliations

  1. Health Strategies International, Oakland, California, USA.
  2. Health Strategies International, Arlington, Virginia, USA.
  3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  4. Department of Global Health, University of Washington, Seattle, Washington, USA.
  5. Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA.
  6. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA Global Health Sciences, University of California, San Francisco, California, USA.

PMID: 24969782 PMCID: PMC4078786 DOI: 10.1136/bmjopen-2013-003987

Abstract

OBJECTIVE: This study estimated the health impact, cost and cost-effectiveness of an integrated prevention campaign (IPC) focused on diarrhoea, malaria and HIV in 70 countries ranked by per capita disability-adjusted life-year (DALY) burden for the three diseases.

METHODS: We constructed a deterministic cost-effectiveness model portraying an IPC combining counselling and testing, cotrimoxazole prophylaxis, referral to treatment and condom distribution for HIV prevention; bed nets for malaria prevention; and provision of household water filters for diarrhoea prevention. We developed a mix of empirical and modelled cost and health impact estimates applied to all 70 countries. One-way, multiway and scenario sensitivity analyses were conducted to document the strength of our findings. We used a healthcare payer's perspective, discounted costs and DALYs at 3% per year and denominated cost in 2012 US dollars.

PRIMARY AND SECONDARY OUTCOMES: The primary outcome was cost-effectiveness expressed as net cost per DALY averted. Other outcomes included cost of the IPC; net IPC costs adjusted for averted and additional medical costs and DALYs averted.

RESULTS: Implementation of the IPC in the 10 most cost-effective countries at 15% population coverage would cost US$583 million over 3 years (adjusted costs of US$398 million), averting 8.0 million DALYs. Extending IPC programmes to all 70 of the identified high-burden countries at 15% coverage would cost an adjusted US$51.3 billion and avert 78.7 million DALYs. Incremental cost-effectiveness ranged from US$49 per DALY averted for the 10 countries with the most favourable cost-effectiveness to US$119, US$181, US$335, US$1692 and US$8340 per DALY averted as each successive group of 10 countries is added ordered by decreasing cost-effectiveness.

CONCLUSIONS: IPC appears cost-effective in many settings, and has the potential to substantially reduce the burden of disease in resource-poor countries. This study increases confidence that IPC can be an important new approach for enhancing global health.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Keywords: Health Economics

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