The cost-effectiveness of three interventions for providing preventive services to low-income children

Hypertension in low-income and middle-income countries (LMICs) is largely undiagnosed and uncontrolled, representing an untapped opportunity for public health improvement. Implementation of hypertension control strategies in low-resource settings depends in large part on cost considerations. However, evidence on the cost-effectiveness of hypertension interventions in LMICs is varied across geographical, clinical and evaluation contexts. We conducted a comprehensive search for published economic evaluations of hypertension treatment programmes in LMICs. The search identified 71 articles assessing a wide range of hypertension intervention designs and cost components, of which 42 studies across 15 countries reported estimates of cost-effectiveness. Although comparability of results was limited due to heterogeneity in the interventions assessed, populations studied, costs and study quality score, most interventions that reported cost per averted disability-adjusted life-year (DALY) were cost-effective, with costs per averted DALY not exceeding national income thresholds. Programme elements that may reduce cost-effectiveness included screening for hypertension at younger ages, addressing prehypertension, or treating patients at lower cardiovascular disease risk. Cost-effectiveness analysis could provide the evidence base to guide the initiation and development of hypertension programmes.

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Is physiotherapy an underused approach to prevent surgery in selective musculoskeletal disorders?

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v20i2.51557 ◽

2021 ◽

Vol 20 (2) ◽

pp. 409-413

Author(s):

Junaid Amin ◽

Sameer Gohir ◽

Umer Qaiser ◽

Ammar A Siddiqui ◽

Freah Alshammary ◽

...

Keyword(s):

Cost Effectiveness ◽

Musculoskeletal Disorders ◽

Low Income ◽

Medical Science ◽

Low Income Countries ◽

Long Term Outcomes ◽

Physiotherapy Intervention ◽

Musculoskeletal Problems ◽

The Cost

Objectives: The purpose of the literature review was to appraise the evidence that an early physiotherapy intervention helps to prevent the surgery in selective musculoskeletal disorders. A search of Google Scholar, Web of Science, Scopus, and PubMed was carried out utilizing the terms (“physiotherapy”, “surgery” OR “exercise, surgery” OR “rehabilitation”, “surgery”). Methods: The article titles and abstracts were screened for eligibility and included in the review. The recent literature evidently emphasized that physiotherapy has opted in selective musculoskeletal problems to avoid and delay surgeries. Results: Regardless of recommended conservative treatment option and effectiveness of physiotherapy, a massive gap can be observed between its evidence and practice. Conversely, overuse of diagnostic imaging, surgeries, and medications is present in clinical practice. In most of the clinical problems the long-term outcomes were reported the same with surgical and physiotherapy intervention. Likewise, patients can also get the advantage of better clinical outcome and cost-effectiveness with physiotherapy as compared to surgical intervention. Conclusion: The cost-effectiveness is an important factor in low-income countries where economic aspects of health care are highly considered. These advantages of physiotherapy should be considered by the clinicians, policymakers, patients, and included in the clinical guidelines. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.409-413

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Addressing low consumption of fruit and vegetables in England: a cost-effectiveness analysis

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1017 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A C Pinho-Gomes ◽

A Knight ◽

J Critchley ◽

M Pennington

Keyword(s):

Cost Effectiveness ◽

Societal Perspective ◽

Low Income ◽

Healthcare Costs ◽

Cost Effective ◽

Fruit And Vegetables ◽

Years Of Life Lost ◽

The Cost ◽

Low Consumption ◽

Low Income Households

Abstract Background Most adults do not meet the recommended intake of five portions per day of fruit and vegetables (F&V) in England, but economic analyses of structural policies to change diet are sparse. This study aimed to estimate (1) the health and economic burden attributable to the low intake of fruit and vegetables (F&V) by English adults, and (2) the cost-effectiveness of three policies promoting consumption of F&V in England - a universal 10% subsidy, a targeted 30% subsidy for low-income households, and a nationwide social marketing campaign (SMC). Methods Using published data from official statistics and meta-epidemiological studies, we estimated the deaths, years-of-life lost (YLL), and the healthcare costs attributable to consumption of F&V below the recommended five portions per day by English adults. Then, we estimated the cost-effectiveness from governmental and societal perspectives of three policies. Results Low consumption of F&V accounted for 16,321 [10,091-23,516] deaths and 238,767 [170,350-311,651] YLL due to cardiovascular diseases, type 2 diabetes and cancer in England in 2017, alongside £705,951 [398,761-1,061,559] million in healthcare costs. From a societal perspective, the incremental cost-effectiveness ratios were £22,891 [22,300-25,079], £16,860 [15,589-19,763], and £25,683 [25,237-28,671] per life-year saved for the universal subsidy, targeted subsidy and SMC, respectively. At a threshold of £20,000 per life-year saved, the likelihood that the universal subsidy, the targeted subsidy and the SMC were cost-effective was 84%, 19% and 5%, respectively. The targeted subsidy was the only policy that would also reduce inequalities. Conclusions Both a SMC and subsidies can significantly increase consumption of F&V and reduce the attributable burden of disease and healthcare costs, but their cost-effectiveness varies substantially. A targeted subsidy to low-income households is most likely cost-effective and can additionally reduce inequalities. Key messages Low intake of fruit and vegetables accounts for a substantial number of deaths and years of life lost and represents a heavy burden for the healthcare system in England. From a societal perspective, a targeted subsidy to low-income households was most likely cost-effective and it would reduce inequalities.

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The cost‐effectiveness of the low‐income housing tax credit relative to vouchers: Evidence from six metropolitan areas

Housing Policy Debate ◽

10.1080/10511482.2005.9521553 ◽

2005 ◽

Vol 16 (3-4) ◽

pp. 469-511 ◽

Cited By ~ 18

Author(s):

Lan Deng

Keyword(s):

Cost Effectiveness ◽

Low Income ◽

Metropolitan Areas ◽

Tax Credit ◽

The Cost ◽

Low Income Housing

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Low-income DSM Programs: Methodological approach to determining the cost-effectiveness of coordinated partnerships

10.2172/10167165 ◽

1994 ◽

Cited By ~ 1

Author(s):

M.A. Brown ◽

L.J. Hill

Keyword(s):

Cost Effectiveness ◽

Low Income ◽

Methodological Approach ◽

The Cost

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Pneumococcal conjugate vaccination in The Gambia: health impact, cost effectiveness and budget implications

BMJ Global Health ◽

10.1136/bmjgh-2021-007211 ◽

2021 ◽

Vol 6 (12) ◽

pp. e007211

Author(s):

Clint Pecenka ◽

Effua Usuf ◽

Ilias Hossain ◽

Sana Sambou ◽

Elisabeth Vodicka ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Low Income ◽

Pneumococcal Vaccination ◽

The Gambia ◽

Low Income Countries ◽

Birth Cohorts ◽

The Cost ◽

Conjugate Vaccination ◽

The Impact

IntroductionIntroducing pneumococcal conjugate vaccine (PCV) in many low-income countries has contributed to reductions in global childhood deaths caused by Streptococcus pneumoniae. Many low-income countries, however, will soon reach an economic status leading to transition from Gavi, the Vaccine Alliance vaccine funding support and then face increased expenditure to continue PCV programmes. Evaluating the cost-effectiveness of PCV in low-income countries will inform such country decisions.MethodsWe used empiric data on the costs of vaccine delivery and pneumococcal disease and PCV programme impact on disease among children less than 5 years old in The Gambia. We used the UNIVAC cost-effectiveness modelling tool to compare the impact and cost-effectiveness of pneumococcal conjugate vaccination to no vaccination over 20 birth cohorts starting in 2011. We calculated costs per disability-adjusted-life-year (DALY) averted from government and societal perspectives and undertook scenario and probabilistic sensitivity analysis.ResultsWe projected that, over 20 years, PCV in The Gambia could avert 117 000 total disease episodes in children less than 5 years old, including outpatient and hospitalised pneumonia, pneumococcal sepsis and meningitis (including sequelae). Vaccination could avert 9000 outpatient pneumonia visits, 88 000 hospitalisations and 3300 deaths due to pneumonia, meningitis and sepsis. Approximately 100 000 DALYs are expected to be averted. Averted visits and hospitalisations represent US$4 million in healthcare costs expected to be saved by the government and US$7.3 million if household costs are included. The cost of the vaccination programme is estimated at US$2 million. In the base scenario, most alternative scenarios and nearly 90% of the probabilistic scenarios, pneumococcal vaccination is cost saving in The Gambia.ConclusionPneumococcal conjugate vaccination is expected to generate substantial health gains and is likely to be cost saving in The Gambia. Policymakers in similar settings should be confident to maintain their PCV programmes.

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The Cost Effectiveness of Preventive Services: Some Examples

Preventing Disease - Frontiers of Primary Care ◽

10.1007/978-1-4612-3280-3_44 ◽

1990 ◽

pp. 435-454

Author(s):

Louise B. Russell

Keyword(s):

Cost Effectiveness ◽

Preventive Services ◽

The Cost

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Financial incentives to Medicaid smokers for engaging tobacco quit line treatment: maximising return on investment

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054811 ◽

2019 ◽

pp. tobaccocontrol-2018-054811

Author(s):

Marlon P Mundt ◽

Timothy B Baker ◽

Megan E Piper ◽

Stevens S Smith ◽

David L Fraser ◽

...

Keyword(s):

Smoking Cessation ◽

Cost Effectiveness ◽

Incremental Cost ◽

Low Income ◽

Financial Incentives ◽

Return On Investment ◽

Incremental Cost Effectiveness Ratio ◽

Control Group ◽

Cost Effectiveness Ratio ◽

The Cost

BackgroundLow-income smokers experience greater difficulty in quitting smoking than do other smokers. Providing financial incentives for treatment engagement increases smoking cessation success. This study models the cost-effectiveness of varying levels of financial incentives to maximise return on investment (ROI) for engaging low-income Medicaid recipients who smoke to take calls from a tobacco quit line.MethodsParticipants (N=1900) were recruited from May 2013 to June 2015 through quit line-based (n=980), clinic-based (n=444) or community-based referrals (n=476) into the Wisconsin Medicaid Quit Line Incentive project. Incentive (n=948) and control group participants (n=952) received $30 versus $0 per call, respectively, for taking up to five Wisconsin Tobacco Quit Line (WTQL) calls. Cost-effectiveness analyses estimated the incremental cost-effectiveness ratio for alternative financial incentives for engagement with WTQL calls. Probabilistic sensitivity analysis was employed to determine an optimal strategy for financial incentives to minimise the cost per individual who quit smoking.ResultsUsing fixed payments, the incremental cost-effectiveness ratio of $2316 per smoker who quit in the randomised trial decreased to $2150 per smoker who quit when the incentives were modelled at $20 per each of five WTQL calls taken. Using variable payments, the minimal cost per additional smoker who quit was $2125 when incentives for the first four WTQL calls were set at $20, and the financial payment for the fifth WTQL call was set at $70.ConclusionsModelling suggests that financial incentives in the amount of $20 per call for taking the first four quit line calls and $70 for taking a fifth quit line call maximise ROI to engage low-income smokers with evidence-based smoking cessation treatment.

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