Average Cost-effectiveness Ratio Research Articles

A patchy theoretical model for the transmission dynamics of SARS-Cov-2 with optimal control

Short-term human movements play a major part in the transmission and control of COVID-19, within and between countries. Such movements are necessary to be included in mathematical models that aim to assist in understanding the transmission dynamics of COVID-19. A two-patch basic mathematical model for COVID-19 was developed and analyzed, incorporating short-term human mobility. Here, we modeled the human mobility that depended on its epidemiological status, by the Lagrangian approach. A sharp threshold for disease dynamics known as the reproduction number was computed. Particularly, we portrayed that when the disease threshold is less than unity, the disease dies out and the disease persists when the reproduction number is greater than unity. Optimal control theory was also applied to the proposed model, with the aim of investigating the cost-effectiveness strategy. The findings were further investigated through the usage of the results from the cost objective functional, the average cost-effectiveness ratio (ACER), and then the infection averted ratio (IAR).

Cost-Effectiveness Analysis of Budesonide/Formoterol and Fluticasone/Salmeterol for Stable Chronic Obstructive Lung Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the four largest types of non-communicable diseases in the world, requiring long-term and routine treatment. Treatment with the inhalation route is in the form of a dry-powder inhaler (DPI) which is easy to use and carry. Combination of corticosteroid and long-acting beta-2 agonist (LABA) in the form of DPI available in Indonesia are budesonide/formoterol and salmeterol/fluticasone. The purpose was to identify therapy was more cost-effective between budesonide/formoterol than fluticasone/salmeterol in clinical symptoms using COPD assessment test (CAT) value and lung function in FEV1/FVC (Forced Expiratory Volume in First Seconds/Forced Vital Capacity) ratio.Methods: This research study was pre-post design with cost-effectiveness analysis, in outpatient COPD patients in a hospital in Gresik Regency, from October 2019 to January 2020. There were two outcomes of respondents in this study, namely lung function seen from the value of FEV1, and clinical symptoms seen from the value of CAT. The study used hospital perspective.Results: There were 38 respondents involved. Fluticasone/salmeterol therapy was more effective than the budesonide/formoterol group in improving FEV1/FVC ratio, while budesonide/formoterol was more effective than the fluticasone/salmeterol group in improving clinical symptoms by CAT assessment. The average cost effectiveness ratio (ACER) value of lung function between the fluticasone/salmeterol group (IDR.176.465/Liter) was lower than that of budesonide/formoterol (IDR.296.832/Liter). The ACER clinical symptoms value between the fluticasone/salmeterol group (IDR.16,283/score) was smaller than that of budesonide/formoterol (IDR.17,340/score). Conclusion: Fluticasone/salmeterol was more cost-effective than budesonide/formoterol in improving lung function. Meanwhile, for clinical symptoms, fluticasone/salmeterol was trade-off with budesonide/formoterol.

Cost Analysis of Antipsychotics Schizophrenia of Inpatients in Mental Hospital West Java Province

Schizophrenia is a mental disorder that can affect behavior, emotions and communication. In the agitation phase ithe patient is acompanied by destructive or violent behavior. In these conditions, the patient must immediately calm down to avoid risk. Monotherapy Treatment in acute agitation schizophrenia is recommended than combination therapy. The purpose of this study was to determine the effectiveness of treatment costs and the factors that influence the total cost of schizophrenia patients at the Mental Hospital of West Java Province. This study was observational by cross sectional study design according to the hospital perspective. This method is retrospective data. The subject were inpatients aged 18-65 years with diagnosis of schizophrenia disorder and receiving antipsychotic therapy for at least 1 month. The results showed that average cost-effectiveness ratio (ACER) Rp.288.659/ 1 score PANSS EC with an average decrease score of 9,70. There is a difference in variant data compared because p-value = 0.011<0,05. ICER calculation of A to C = (Rp. 2.800.001–Rp. 2.593.821) / (9.70 - 8.57) = Rp. 182.460. The factors that influence the total cost found that the most significant are administration and room. The conclusion is atypical-atypical monotherapy recommended as a treatment for schizophrenic in agitation acute.

The long-term growth, cost-effectiveness, and glycemic effects of growth hormone therapy on children born small for gestational age over 10years: a retrospective cohort study.

We aimed to report our 10-year experience of treating short children born small for gestational age (SGA) by comparing the long-term growth, metabolic safety, and cost-effectiveness of recombinant human growth hormone (rhGH) therapy in short children born SGA with those in rhGH-treated children with growth hormone deficiency (GHD) and Turner syndrome. We performed a 10-year retrospective cohort study at King Saud University Medical City. We included children aged 3-16years who received rhGH for GHD, SGA, or Turner syndrome for >1year. A total of 166 children received rhGH therapy for GHD, 58 for SGA, and 16 for Turner syndrome. During the last study visit, the average height change was 21cm for GHD children and 14cm for children born SGA (p-value <0.001). The height SDS change was 0.84 forGHD children and 0.55 for SGA children (p-value=0.004). The average cost-effectiveness ratios for treating GHD and SGA children were USD 1,717.22 and USD 1,157.19 per centimeter gained, respectively. Moreover, the mean incremental cost-effectiveness ratio for GHD vs. SGA patients was USD 2,820.39 per centimeter gained. Dysglycemia developed in 70 patients: 43 (36.44%), 22 (40.74%), and 5 (13%) in the GHD, SGA, and Turner syndrome groups, respectively. rhGH is effective in height improvement of short children. However, pursuing rhGH treatment for children born SGA requires a shared decision-making approach to balance the modest benefit of final adult height gain with the long-term metabolic effects, considering the acceptable costs on the Saudi healthcare system.

Deciphering the transmission dynamics of COVID-19 in India: optimal control and cost effective analysis

In this paper we assess the effectiveness of different non-pharmaceutical interventions (NPIs) against COVID-19 utilizing a compartmental model. The local asymptotic stability of equilibria (disease-free and endemic) in terms of the basic reproduction number have been determined. We find that the system undergoes a backward bifurcation in the case of imperfect quarantine. The parameters of the model have been estimated from the total confirmed cases of COVID-19 in India. Sensitivity analysis of the basic reproduction number has been performed. The findings also suggest that effectiveness of face masks plays a significant role in reducing the COVID-19 prevalence in India. Optimal control problem with several control strategies has been investigated. We find that the intervention strategies including implementation of lockdown, social distancing, and awareness only, has the highest cost-effectiveness in controlling the infection. This combined strategy also has the least value of average cost-effectiveness ratio (ACER) and associated cost.

Backward Bifurcation Emerging from a Mathematical Model of African Animal Trypanosomiasis Disease in White Rhino Populations

This paper introduces a mathematical model for African animal trypanosomiasis (AAT) in white rhino and tsetse fly populations. The model accommodates two types of interventions, namely infection detection and ground spraying. The dynamical system properties were thoroughly investigated to show the existence of equilibrium points, backward bifurcation, and how they are related to the basic reproduction number. We found that there is a chance that AAT may die out from the population if the basic reproduction number is smaller than one. However, the possible existence of backward bifurcation implies a condition where we may have a stable endemic equilibrium, even when the basic reproduction number is smaller than one. Hence, the basic reproduction number is no longer sufficient to guarantee the disappearance of AAT from the population. Our sensitivity analysis on the basic reproduction number showed that the interventions of infection detection and ground spraying have good potential to eradicate AAT from the population. To analyze the most effective intervention as time-dependent variable, we reconstructed our model as an optimal control problem. Numerical simulations on various scenarios were conducted for the optimal control problem. Cost-effectiveness analysis using the Average Cost-Effectiveness Ratio (ACER) and the Incremental Cost-Effectiveness Ratio (ICER) methods was performed. From the cost-effectiveness analysis, we found that ground spraying is the most cost-effective intervention to combat the spread of AAT in white rhino populations.

Cost-Effectiveness of Presbyopia Correction Among Seven Strategies of Bilateral Cataract Surgery Based on a Prospective Single-Blind Two-Center Trial in China.

The aim of this study was to explore a method to rank the cost-effectiveness of presbyopia correction in diverse strategies of bilateral cataract surgery to provide references for healthcare policymakers in rationalizing resource utilization and surgeons in customizing patient management. The cost-effectiveness analysis based on a prospective single-blind two-center clinical trial included seven strategies in bilateral cataract surgery: monofocal, monovision, diffractive bifocal, blended, refractive bifocal, trifocal, and extended depth of focus (EDOF) strategies. The effectiveness according to the objective spectacle independence rate (hereafter "rate", a novel indicator defined as the proportion of patients with binocular uncorrected distance, intermediate and near visual acuity all better than 0.1logMAR, logarithm of the minimum angle of resolution), costs, average cost-effectiveness ratios (ACERs, $/1% rate), and incremental cost-effectiveness ratios (ICERs, $/1% incremental rate) were estimated. In 194 participants (388 eyes), the trifocal strategy achieved the highest rate [93.10% (95% confidence interval (CI) 83.8-102.35%)]. The refractive bifocal strategy had the minimum ACER [$45.54/1% rate (95%CI 34.57-56.50)], followed by the blended [$59.10/1% rate (95%CI 31.72-86.48)], diffractive bifocal [$69.06/1% rate (95%CI 30.89-107.21)], EDOF [$72.85/1% rate (95%CI 52.02-93.70)], trifocal [$93.01/1% rate (95%CI 83.23-102.79)], monovision [$136.83/1% rate (95%CI - 55.40 to 329.14)], and monofocal [$264.45/1% rate (95%CI - 97.45 to 626.55)] strategies. Compared with the refractive bifocal strategy, the probabilities that the trifocal strategy (ICER $289.74/1% incremental rate) is very cost-effective and cost-effective were 81.7% and 93.2%, respectively, at the wiliness-to-pay threshold of one and three times China's annual disposable income per capita in 2021 per 10% incremental rates. Cost-effectiveness analysis with ACER and ICER according to objective spectacle independence rate is a helpful tool to identify highly cost-effective presbyopia-correcting strategies in cataract surgery for clinical and policy decisions. Clinicaltrials.gov (NCT04265846).

Drug Utilization and Pharmacoeconomic Evaluation of Oral Hypoglycemic Agents in the Endocrinology Department of a Tertiary Care Hospital

The objective of the study was to assess the drug utilization pattern and pharmacoeconomic evaluation of oral hypoglycemic agents in a tertiary care hospital. A prospective observational study was conducted among 153 diabetic patients above 18 years who visited the endocrinology outpatient department for 6 months, and who were prescribed at least one oral hypoglycemic agent. Cost-effectiveness was calculated using the Average Cost-Effectiveness Ratio. Drug utilization pattern of Oral Hypoglycemic Agents monotherapy showed that Metformin was utilized more in that hospital (n=35). Among combination therapy, Glimepiride + Metformin combination was prescribed the most (n=66). The average number of drugs per encounter was 5.88. 18.2% of drugs were prescribed by generic name. 17.64 of drugs encounter with an antibiotic. 13.07% of drug encounters with injections. 55.82% of drugs were prescribed from the Essential Drug List. Among the diabetes population, Metformin was the most utilized drug, followed by Vildagliptin, and Glimepiride + Metformin combination was utilized most. Overall, the prescribing trend of drugs was found to be irrational. Cost-effectiveness analysis found that Glimepiride 1 mg was the cost-effective drug, and also found that the combination of Glimepiride 0.5mg+ Metformin 500 mg was the cost-effective hypoglycemic agent.

Cost-effectiveness analysis of metformin and metformin-glimepiride in patients with type 2 diabetes at nene mallomo sidrap general hospital

Metformin and metformin-glimepiride are cost-effective therapy options and are most commonly prescribed to treat type 2 diabetes mellitus (DM). This study aims to determine the cost-effectiveness of using metformin and metformin-glimepiride in patients with type 2 DM at Nene Mallomo Sidenreng Rappang General Hospital. This analytical descriptive observational research employed a retrospective cohort design. The data of type 2 DM patients, new and old patients, were obtained from the medical record unit. The target population was data of outpatients for the period January-December 2019. The parameter of the therapeutic effectiveness is the random blood sugar levels of the patients after receiving treatment. The data on cost from the hospital perspective were obtained from the administration and finance unit. Cost-effectiveness analysis employed calculations of the average cost-effectiveness ratio (ACER) and the incremental cost-effectiveness ratio (ICER). Meanwhile, the risk ratio (RR) employed the analytical chi-squared method to determine the relationship between the two types of therapies and their effectiveness. This study has revealed that 30 patients met the inclusion criteria; 14 patients received metformin therapy and 16 patients received metformin-glimepiride therapy. Metformin therapy is more effective (64.29%) and more costly (IDR120,736). The metformin's ACER value is 1877.99, and its ICER value is -3107.26. The cost-effectiveness analysis has revealed that metformin therapy is more cost-effective than metformin-glimepiride therapy. Meanwhile, the chi-squared analysis has discovered no relationship between the two therapies and their effectiveness. The RR value of 1.080 concludes that metformin has 1.080 as much therapeutic effectiveness as the metformin-glimepiride.

Analisis Efektivitas Biaya dan Minimal Biaya Pasien Diabetes Melitus Tipe 2 di RSUD Abdul Wahab Sjahranie Samarinda Tahun 2019

Diabetes mellitus (DM) is a metabolic disorder and characterized by hyperglycemia and disorders of the metabolism of carbohydrates, fats, proteins. The purpose of this study was to determine the characteristics of Diabetes mellitus patients, the pattern of treatment carried out, and appropriate anti diabetic in terms of cost and effectiveness aspects at Abdul Wahab Sjahranie Regional Hospital Samarinda. The study was conducted retrospectively on medical record records. The results of 115 patients showed that most Diabetes mellitus sufferers were suffered by man with an age range of 56-65 years. The most common use of anti diabetic in Diabetes mellitus patients is bolus insulin and combination of bolus and basal insulin. Anti diabetic with minimal cost or the most minimal cost are the cost of using bolus insulin at a cost of Rp 8.865.248,-. The antidiabetics combination of basal and bolus is more effective reducing blood sugar levels while 174,86 mg/dL with an average cost effectiveness ratio (ACER) value of Rp 57.199,22,-.

Cost-Effectiveness Analysis to Inform Randomized Controlled Trial Design in Chronic Pain Research: Methods for Guiding Decisions on the Addition of a Run-In Period.

Run-In (RI) periods can be used to improve the validity of randomized controlled trials (RCTs), but their utility in Chronic Pain (CP) RCTs is debated. Cost-effectiveness analysis (CEA) methods are commonly used in evaluating the results of RCTs, but they are seldom used for designing RCTs. We present a step-by-step overview to objectively design RCTs via CEA methods and specifically determine the cost effectiveness of a RI period in a CP RCT. We applied the CEA methodology to data obtained from several noninvasive brain stimulation CP RCTs, specifically focusing on (1) defining the CEA research question, (2) identifying RCT phases and cost ingredients, (3) discounting, (4) modeling the stochastic nature of the RCT, and (5) performing sensitivity analyses. We assessed the average cost-effectiveness ratios and incremental cost effectiveness ratios of varied RCT designs and the impact on cost-effectiveness by the inclusion of a RI period vs. No-Run-In (NRI) period. We demonstrated the potential impact of varying the number of institutions, number of patients that could be accommodated per institution, cost and effectiveness discounts, RCT component costs, and patient adherence characteristics on varied RI and NRI RCT designs. In the specific CP RCT designs that we analyzed, we demonstrated that lower patient adherence, lower baseline assessment costs, and higher treatment costs all necessitated the inclusion of an RI period to be cost-effective compared to NRI RCT designs. Clinical trialists can optimize CP RCT study designs and make informed decisions regarding RI period inclusion/exclusion via CEA methods.

Remote Health Interventions: Effectiveness, Cost, and Cost-Effectiveness Considerations.

Remote Health Interventions: Effectiveness, Cost, and Cost-Effectiveness Considerations.

Understanding implementation costs of a pediatric weight management intervention: an economic evaluation protocol

BackgroundUnderstanding the cost and/or cost-effectiveness of implementation strategies is crucial for organizations to make informed decisions about the resources needed to implement and sustain evidence-based interventions (EBIs). This economic evaluation protocol describes the methods and processes that will be used to assess costs and cost-effectiveness across implementation strategies used to improve the reach, adoption, implementation, and organizational maintenance of an evidence-based pediatric weight management intervention- Building Health Families (BHF).MethodsA within-trial cost and cost-effectiveness analysis (CEA) will be completed as part of a hybrid type III effectiveness-implementation trial (HEI) designed to examine the impact of an action Learning Collaborative (LC) strategy consisting of network weaving, consultee-centered training, goal-setting and feedback, and sustainability action planning to improve the adoption, implementation, organizational maintenance, and program reach of BHF in micropolitan and surrounding rural communities in the USA, over a 12-month period. We discuss key features of implementation strategy components and the associated cost collection and outcome measures and present brief examples on what will be included in the CEA for each discrete implementation strategy and how the results will be interpreted. The cost data will be collected by identifying implementation activities associated with each strategy and using a digital-based time tracking tool to capture the time associated with each activity. Costs will be assessed relative to the BHF program implementation and the multicomponent implementation strategy, included within and external to a LC designed to improve reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of BHF. The CEA results will be reported by RE-AIM outcomes, using the average cost-effectiveness ratio or incremental cost-effectiveness ratio. All the CEAs will be performed from the community perspective.DiscussionThe proposed costing approach and economic evaluation framework for dissemination and implementation strategies and EBI implementation will contribute to the evolving but still scant literature on economic evaluation of implementation and strategies used and facilitate the comparative economic analysis.Trial registrationClinicalTrials.gov NCT04719442. Registered on January 22, 2021.

COST EFFECTIVENESS ANALYSIS (CEA) PENGGUNAAN GOLONGAN OBAT NEUROPROTEKTAN CITICOLINE INJEKSI DAN PIRACETAM INJEKSI PADA PASIEN STROKE DI RSU IMELDA PEKERJA INDONESIA MEDAN

Stroke is disease or functional disorder of the brain in the form of nerve paralysis (neurological deficit) due to obstruction of blood flow to the brain. One of the therapies given to stroke patients is by giving neuroprotectant drugs, namely citicoline injection and piracetam injection. The purpose of this study was to determine the effectiveness of therapy and cost effectiveness of stroke patients' therapy between the use of alternative citicoline injection and injection piracetam in a pharmacoeconomic manner with a Cost Effectiveness approach in RSU Imelda Pekerja Indonesia Medan. This study uses a retrospective Cohort Study method. The sample of this study consisted of 44 patients, namely 22 patients treated with citicoline injection and 22 patients treated with piracetam injection. The results of this study were obtained from the comparison of ACER (Average Cost Effectiveness Ratio) and ICER (Incremental Cost Effectiveness Ratio) values. The ACER value of citicoline injection is Rp. 11.949.- less than the ACER value of piracetam Rp. 15.474.- so that the Cost Effective ACER value which has the lowest ACER value is citicoline injection. The ICER value of the comparison of citicoline injection and injection piracetam is Rp. -32.661.- . which means the ICER result is negative or getting smaller, it is considered more effective and cheaper, in accordance with quadrant II the plant's cost-effectiveness decreases so that the neuroprotectant drug class therapy with the most Cost Effectiveness of stroke patients in RSU Imelda Pekerja Indonesian Medan is citicoline injection.

Stability, cost-effectiveness, and global sensitivity analysis of COVID-19 model incorporating non-pharmaceutical interventions and indirect transmission

Covid-19 is an ongoing pandemic caused by SARS-CoV-2. Some interventions are implemented to control the spread of the disease. In Indonesia, there is a campaign related to non-pharmaceutical approach called 3M. This campaign is carried out so that people use masks, wash their hands, and keep their distance. In this paper, we propose a mathematical model considering non-pharmaceutical interventions and indirect transmission. The non-pharmaceutical interventions studied are the implementation of mask-wearing, handwashing, and social distancing. The model is presented as a system of first-order differential equations. The basic reproduction number is determined. The system has two equilibrium points, namely the disease-free equilibrium point and the endemic equilibrium point. The local stability condition of the disease-free equilibrium point is proved using the Lienard-Chipart criterion. Center manifold theory is used to prove the local stability condition of the endemic equilibrium point. We also study the optimal control strategy related to mask-wearing, handwashing, and social distancing. Furthermore, cost-effectiveness analysis of intervention strategies is also conducted by studying the average cost-effectiveness ratio of each intervention strategy. Our results show that the most effective strategy to control covid-19 spread is the combination of mask-wearing, handwashing, and social distancing. Moreover, the most cost-effective strategy is mask-wearing intervention. Global sensitivity analysis is performed by studying the partial rank correlation coefficient. The results show that mask-wearing intervention is the most influential intervention on basic reproduction number compared to social distancing and handwashing

Optimal Control and Cost-Effectiveness Analysis in An Epidemic Model with Viral Mutation and Vaccine Intervention

This paper introduces an optimal control problem in a two-strain SIR epidemic model with viral mutation and vaccine administration. The purpose of this study was to investigate the efficacy and cost-effectiveness of two disease prevention strategies, namely restriction of community mobility to prevent disease transmission and vaccine intervention. We consider the time-dependent control case, and we use Pontryagin’s Maximum Principle to derive necessary conditions for the optimal control of the disease. We also calculate the Average Cost-Effectiveness Ratio (ACER) and the Incremental Cost-Effectiveness Ratio (ICER) to investigate the cost-effectiveness of all possible strategies of the control measures. The results of this study indicate that the most cost-effective disease control strategy is a combination of mobility restriction and vaccination.

The Cost-Effectiveness of Hyperlipidemia Medication in Low- and Middle-Income Countries: A Review.

Hyperlipidemia is a risk factor for cardiovascular disease – the leading cause of death globally. Increased understanding of the cost-effectiveness of hyperlipidemia treatment in low- and middle-income countries can guide approaches to hyperlipidemia management in resource-limited environments. We conducted a systematic review of the evidence on the cost-effectiveness of hyperlipidemia medication treatment in low- and middle-income countries using studies published between January 2010 and April 2020. We abstracted study details, including study design, treatment setting, intervention type, health metrics, costs standardized to constant 2019 US dollars, and cost-effectiveness measures including average and incremental cost-effectiveness ratios. Comparisons across studies suggested that treatment via polypill is generally more cost-effective than statin-only therapy, and that primary prevention is more cost-effective than secondary prevention. Treating hyperlipidemia at a threshold of 5.7 mmol/l comes at a higher cost per disability-adjusted life-years averted than at a threshold of 6.2 mmol/l. Most pharmacological treatment strategies for hyperlipidemia were found to be cost-effective in most of the examined low- and middle-income countries.

Analisis Efektivitas Biaya Pasien PROLANIS DM Tipe 2 di Puskesmas Kota Bandung

Diabetes mellitus is one of chronic diseases with high treatment cost. Purpose of this research was to analyze the cost-effectiveness of (Prolanis) for patients with type 2 DM and to establish the most significance parameter affecting the cost-effectiveness value. This study is a non-experimental retrospective by collecting medical record data of Prolanis patients with type 2 DM at Bandung Health Center during 2015 and 2016 with 246 samples that met the inclusion criteria. Cost-effectiveness analysis was conducted by calculating Average Cost Effectiveness Ratio (ACER) and Incremental Cost Effectiveness Ratio (ICER). In particular, sensitivity analysis was conducted to investigate the most significance parameter affecting those ratios. The result of unpaired t test confirmed that there was not significance difference on ACER values of 2015 and 2016, whereas the value of arithmetic (0,202) &lt; t table (4,303) with significance value ? 0,04 &lt;0,05. The implementation of Prolanis in 2015 (ACER = Rp. 1.095,97) seemed to be more cost effective than in 2015 (ACER = Rp. 1.268,96). Cost of biguanida drugs is the most influential factor affecting the cost-effectiveness values of Prolanis implementation in patients with type 2 DM in 2015 and 2016.

The Cost-Effectiveness Analysis of the Productivity Measurement and Enhancement System Intervention to Reduce Employee Work-Related Stress and Enhance Work Performance.

Background: The study evaluates the cost-effectiveness of the Productivity Measurement and Enhancement System (ProMes) intervention to reduce employee work-related stress and enhance work performance. Methods: A prospective cohort study was used to undertake the evaluation from a business perspective. Objective workload data and stress were gathered repeatedly over a 17-month period (i.e., before and after intervention). Independent t-test and an interrupted time series (ITS) analysis were used in the analysis. The average cost-effectiveness ratio (ACER) was calculated as a ratio of the average cost of the intervention and the effect sizes of the different outcomes to reflect the average cost per clinician for each unit change in outcome. Results: Based on the results of the ITS analysis, an expenditure of EUR 41,487 was linked with no change in stress levels, according to the ACER for stress. In addition, the expenditures associated with each unit change were EUR 3319 for overall tasks per hour worked, EUR 2761 for visits per hour worked, EUR 2880 for administrative tasks, but EUR 9123 for answering phone calls. Conclusions: ProMes is not cost–effective in terms of work-related stress levels, but the intervention seemed to have increased efficiency in some objective work performance measures, albeit at a relatively high extra cost.

Economic evaluation of severe malaria in children under 14\xa0years in Zambia

IntroductionMalaria exerts a significant economic burden on health care providers and households and our study attempts to make claims on the cost effectiveness of artesunate against quinine in patients under 14 years of age in Zambia. Also, to find the average total costs involved in the treatment of severe malaria in children and their impact on household expenditure.MethodsCost-effectiveness analysis of severe malaria treatment was conducted from a healthcare provider perspective using a Markov model. Standard costing was performed for the identification, measurement and assessment phases with data from quantification reports for anti-malaria commodities as these documents provides drug procurement costs from suppliers and freight costs. Average and incremental cost-effectiveness ratio were estimated and uncertainties were assessed through probabilistic sensitivity analysis.ResultsIn Zambia severe malaria in children has been shown to account for over 45% of the total monthly curative healthcare costs incurred by households compared to the mean per capita monthly income. The cost of treating severe malaria depleted 7.67% of the monthly average household income. According, to the cost effectiveness analysis the of artesunate with quinine the ICER was $105 per death averted.ConclusionThe use of artesunate over quinine in the treatment of severe malaria in children under 14 years is a highly cost-effective strategy for the healthcare provider in Zambia.