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

Abstract

ObjectiveThis 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.MethodsWe 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 outcomesThe 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.ResultsImplementation 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.ConclusionsIPC 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.

The pitfalls of scaling up evidence-based interventions in health

“…They related to cost-effectiveness, equity, harms, ethics, bottom-up/top-down scaling-up, and the context in which the EBI was scaled up (see Figure 2). To discuss them, we identified 45 scaling-up studies that raised these difficulties, of which 13 were on costeffectiveness estimates or cost-analysis models [22][23][24][25][26][27][28][29][30][31][32][33][34], 14 on equity [35][36][37][38][39][40][41][42][43][44][45][46][47][48], four on harms [16,[49][50][51][52], three on ethics [53][54][55], six on top-down implementation [42,[56][57][58][59][60], and eight on contextual problems [40,43,[61][62][63][64]…”

“…Cost-effectiveness estimates need to consider the size of the targeted population, the incidence or prevalence of the disease or risk factor, the significance of the intervention's efficacy, and the amount spent or available [29]. Thus while many modelling studies show scalingup EBIs to be cost-effective [22][23][24]26,27,[30][31][32][33][34], they may not reflect the multi-factorial complexity of the real world. Categorical universal statements about the cost-effectiveness of scaling-up are thus difficult to justify.…”

Feasibility and Efficacy of a Urologic Profession Campaign on Cryptorchidism Using Internet and Social Media

“…Besides social media campaigns, traditional mass media campaigns have been shown to be a cost-effective tool in reducing the disease burden, especially in resourcepoor countries [20] . However, the recent urologic mass media campaign 'blood in pee' has not led to a significant change in the diagnosis of targeted cancers across a large catchment [21] .…”

HPV‐based cervical cancer screening in low‐resource settings: Maximizing the efficiency of community‐based strategies in rural Kenya

“…6,8,9 A cost-effectiveness study comparing strategies for cervical cancer screening across five low-and middle-income countries found that strategies requiring fewer visits were also more efficient. 11,12 CHCs may similarly be an effective strategy to deliver cervical cancer screening rates in high-burden communities because of high capacity and proximity to residential areas. 11,12 CHCs may similarly be an effective strategy to deliver cervical cancer screening rates in high-burden communities because of high capacity and proximity to residential areas.…”

“…10 The community-based health fair, or community health campaigns (CHCs), is an effective and cost-effective strategy to deliver screening and preventive health services in low-resource contexts. 11,12 CHCs may similarly be an effective strategy to deliver cervical cancer screening rates in high-burden communities because of high capacity and proximity to residential areas.…”