One Step Back, Two Steps Forward: An Economic Evaluation of the PEN Program in Indonesia

Rattanavipapong, Waranya; Luz, Alia; Kumluang, Suthasinee; Kusumawardani, Nunik; Teerawattananon, Yot; Indriani, Co-investigators: Dewi; Primastuti, Priska Apsari; Rivai, Lily Banonah; Idaiani, Sri; Adhie, Ully; Anothaisintawee, Thunyarat; Chootipongchaivat, Sarocha; Teerawattananon, Kanlaya; Paliwal, Purvi; Singh, Devika

doi:10.1080/23288604.2015.1124168

Cited by 18 publications

(38 citation statements)

References 27 publications

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“…If price reductions for drugs and tests are achieved, HCV elimination would become even more cost‐effective. The ICERs presented compare favourably to the ICERs associated with other proposed interventions in Indonesia such as an improved targeted screening policy for noncommunicable disease (~3700 per disability‐adjusted life year [DALY] averted), school‐based delivery of the oral cholera vaccine (~$2500 per DALY averted), and improved sanitation interventions ($1400‐$2700 per DALY averted)…”

Section: Discussionmentioning

confidence: 91%

“…If the cost of drugs and VL testing are lowered together as in price reduction 4, elimination would generate an ICER of $300 per YLS, less than a tenth of Indonesia's GDP per capita. Even at baseline prices for DAAs and VL testing, the ICER for HCV elimination compares favourably to the ICERs associated with the proposed scale‐up of other disease interventions in Indonesia …”

Section: Resultsmentioning

confidence: 98%

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Hepatitis C virus elimination in Indonesia: Epidemiological, cost and cost‐effectiveness modelling to advance advocacy and strategic planning

Trickey

Hiebert

Perfect³

et al. 2019

Liver International

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Backgrounds & Aims:In Indonesia 1.9 million people are chronically infected with hepatitis C virus (HCV), but a national strategic plan for elimination has not yet been developed, despite the availability of low-cost treatments which could save many lives. We used epidemiological and cost modelling to estimate targets and resource requirements of a national elimination program and explore the potential impact and cost-effectiveness. Methods: To model the HCV epidemic, we used a dynamic model, parameterised with Indonesia-specific data, accounting for disease progression, injecting drug use and demographics. Future scale-up scenarios were designed for 2018-2050 to capture possible policy choices. Costs of an initial 5-year national strategy and of long-term elimination were estimated for the most feasible scenario, as agreed with government and local partners. Cost savings from reduced drug and diagnostics prices were also estimated. The cost-effectiveness of baseline predictions and those with drug price reductions were compared to the no treatment scenario. Results: Elimination by 2045, considered the most feasible path to scale-up, would prevent 739 000 new infections and avert 158 000 HCV-related deaths. The costs would be $5.6 billion (USD) using baseline prices but could fall to $2.7 billion if price reductions for HCV drugs and diagnostics are secured. With these price reductions, the incremental cost-effectiveness ratio for a 2045 elimination program would be cost-effective at $300 (USD) per year of life saved vs the no treatment scenario. Conclusions:This study has underpinned advocacy efforts to secure Indonesian government commitment to HCV elimination, and provides further inputs for HCV strategic planning efforts. | 287TRICKEY ET al. | Scenario designTo understand the range of possible policy responses, we modelled treatment scale-up scenarios of varying elimination timeframes and scale-up intensity. The WHO definition for elimination is an 80% reduction in HCV incidence and a 65% reduction in HCV-related mortality from 2015 levels.

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Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 98%

Hepatitis C virus elimination in Indonesia: Epidemiological, cost and cost‐effectiveness modelling to advance advocacy and strategic planning

Trickey

Hiebert

Perfect³

et al. 2019

Liver International

View full text Add to dashboard Cite

show abstract

“…Concerning the target populations four studies included people aged 40 years and above (13)(14)(15)(16), three studies included people aged 50 years and above (17)(18)(19), two studies included age 30 years and above (20,21) and two studies included age 15 years and above (Table 2) (22,23).…”

Section: Resultsmentioning

confidence: 99%

“…An Economic Evaluation of the PEN Program in Indonesia showed that implementing screening targeted at high-risk groups of population aged 40 and above is cost-effective when compared with no screening. Screening will result in cost savings for the government and a possibility to reallocate resources to the country's priority health concerns, consequently leading to better health outcomes (16).…”

Section: Cost-effectiveness Analysis Of Screening For and Managing Idmentioning

confidence: 99%

Cost-effectiveness of Comprehensive screening of general population for hypertension: Can it save money and Life? Systematic review of Pharmacoeconomic Studies

Davari¹,

Sorato²,

Nikfar³

2020

Preprint

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Background: Hypertension is one of major modifiable risk factors contributing for development of ischemic heart disease, diabetes, kidney disease, cerebrovascular disease and peripheral arterial disease. Silent nature of the disease, delayed presentation of patients to health system after development of significant cardiovascular events and poor access to comprehensive health care are major challenge of hypertension control. Early screening, detection and treatment of hypertension is effective for control of the disease progression. However, there is no robust evidence on whether screening general population for hypertension is cost-effective or not. Therefore, this review was conducted t o generate evidence on cost effectiveness of population-based hypertension screening for asymptomatic individuals as early detection strategy for the primary prevention of cardiovascular diseases. Methods: PubMed/Medline , Scopus, Web of sciences and Google Scholar were searched from January 2000 to 11 December 2019. Two investigators independently selected and reviewed fair and good-quality pharmacoeconomic studies for the cost-effectiveness of asymptomatic screening for hypertension in the community. Quality of selected literatures are evaluated by authors based on comprehensive tool developed for critical appraisal of pharmacoeconomic studies. Results: Eleven included Pharmacoeconomic studies reported favorable results for screening asymptomatic adults for hypertension. Most of studies agreed on cost-effectiveness of screening adults aged 40 years and older. Screening of general adult population for hypertension is not-cost effective. Conclusion: Screening population 40 years and older with or without additional risk factors is cost-effective in reducing hypertension and associated cardiovascular disease morbidity and mortality in developed and developing countries.

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“…The program was cost-saving. 33 Health caravans have been used in Tajikistan since 2009 to improve access to health care in rural and remote areas. 34 While health caravans have been used sporadically for outreach, a systematic approach to using them could facilitate broader awareness of hypertension, screening for early diagnosis, and follow-up of care within the community.…”

Section: Figure 6 Addressing Drop-offs In the Continuity Of Care For mentioning

confidence: 99%

Identifying Opportunities to Strengthen Service Delivery for Hypertension in Tajikistan

Chukwuma¹,

Fraser‐Hurt²,

Gong³

et al. 2019

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One Step Back, Two Steps Forward: An Economic Evaluation of the PEN Program in Indonesia

Cited by 18 publications

References 27 publications

Hepatitis C virus elimination in Indonesia: Epidemiological, cost and cost‐effectiveness modelling to advance advocacy and strategic planning

Hepatitis C virus elimination in Indonesia: Epidemiological, cost and cost‐effectiveness modelling to advance advocacy and strategic planning

Cost-effectiveness of Comprehensive screening of general population for hypertension: Can it save money and Life? Systematic review of Pharmacoeconomic Studies

Identifying Opportunities to Strengthen Service Delivery for Hypertension in Tajikistan

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