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Donald S. Shepard, Ph.D.Schneider Institutes for Health Policy
Heller School, MS 035Brandeis University
Waltham, MA 02454-9110 USA
Presented to the STAG, NTD, WHOApril 17, 2008
Tel: +1-781-736-3975 • Fax: +1-888-429-2672Web: http://www.sihp.brandeis.edu/shepard
E-mail: [email protected]
Health economic impact of NTDs
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Goals of economic analysis
1. Improve understanding of economic impact of NTDs
2. Offer strategic advice within a disease
3. Offer strategic advice across diseases4. Strengthen implementation
(forecasting and efficiency)
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1 Economic impact of NTDs
• Value of resources:– Used in control– Lost from economic impact of illness and
premature death
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Conceptual terminology
DIRECT MEDICAL (I.E.TREATMENT)
CONTROL
Indirect
Indirect medical
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Estimating economic impact: varying perspectives
Donor (expenditure)
Government
Household
Employer
Societal perspective: sum
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Approach for estimating control cost
Total cost of each component =
Unit costx
Quantity
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Approach for estimating illness cost
Cost per case by its most intensive treatment setting (e.g., community, clinic, hospital)
X
Number of cases treated in that setting
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Data sources for illness cost, 1Cost per case by its most intensive treatment
setting (e.g., community, clinic, hospital)-survey patient or family
-infer from medical record-use international dollars based on Purchasing
Power Parity to standardize costs across countries
xNumber of cases treated in that setting
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Data sources for illness cost, 2Cost per case by its most intensive treatment setting
(e.g., community, clinic, hospital)x
Number of cases treated in that setting-(use as applicable) cases notified and applicable
expansion factors-population-based or school-based survey
-adjust for geographical factors-capture-recapture methodology
-disease registries-relations to other known demographic information,
such as births-relations to vector information
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Economic and Health Burden of Dengue in Eight Countries
Jose A. Suaya, MD PhD MPH MBADonald S. Shepard, PhD
Schneider Institutes for Health PolicyHeller School, Brandeis University
ASTMH, November 7, 2007
Example: dengue
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Countries and sites
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Country principal investigators, Americas
BRAZILDr. Joao B. Siqueira
EL SALVADORDr. Romeo Montoya
GUATEMALALic. Leticia Castillo
Panama
PANAMADr. Blas Armien
VENEZUELA:
Dr. Fatima Garrido
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Country principal investigators, Asia
CAMBODIADr. Ngan Chantha
MALAYSIADr. Lucy Lum Chai See
THAILANDDr. Sukhontha Kongsin
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Household days affected per hospitalized dengue episode
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1718
16
22
20
23
16
19
0
5
10
15
20
25
Entirecohort
BRA ESAL GUA PAN VEN CAM MAL THA
Country
Day
s
Other Household membersPatient
Household days affected per hospitalized case
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Cost per case in ambulatory cohort
12151 48
132 90
447
142
579
133 110
399
128
219
372
$699
$184 $158
$531
$218
$666
$514
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
BRA ESAL GUA PAN VEN CAM MAL THA ALL
Country
Cos
t per
cas
e (I$
)
Total costIndirect costDirect cost
Ambulatory, cost of a non-fatal case
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Cost per case in hospitalized cohort
782 790651
1,189
610393
1,7391,621
1,058
840
170
102
515
204
363
249
137
336
$1,622
$960
$752
$1,704
$815$756
$1,988
$1,758
$1,394
$0
$500
$1,000
$1,500
$2,000
$2,500
BRA ESAL GUA PAN VEN CAM MAL THA ALL
Country
Cos
t per
cas
e (I$
)
Total costIndirect costDirect cost
Hospitalized, cost of a non-fatal case
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Cost of dengue in Panama, 2005*
ItemPanama
All
Non-fatal dengue, US$ 11,269,187 Fatal dengue, US$ 558,680 Subtotal, US$ 11,827,867
Cost, US$ 4,536,090
Total cost, US$ 16,363,956 Total cost/capita, US$/capita 5.07
Dengue all cost
Surveillance, laboratory and vector control
Dengue illness
*Blas Armien, et al.; Am J Trop Med & Hygiene, accepted pending revision, 2008
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2. Offer trategic advice within a disease: cost-effectiveness analysis
• Example from dengue, compare:– Status quo: no dengue vaccine– New: dengue vaccine included in routine
childhood immunizations
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Shepard, D.S., Suaya, J.A., Halstead, S. B., Nathan, M. B., Gubler, D. J., Mahoney, R. T.,
Wang, D. N. C., Meltzer, M.I. Cost-effectiveness of a pediatric dengue vaccine.
Vaccine 22(9-10): 1275-1280, 2004.
Source
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Rates in dengue model
Population
Infection
Clinical Cases
DHF/DSS
Death
5%
94% 6%
0.8%
Asym ptom aticInfection
DF(Non-DHF)
Survive
76% 24%
99.2%
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Results: most likely value and sensitivity analysis
Impact of DHF Rates and Public Sector Cost of Vaccine on Cost-Effectiveness
(US$/DALY Gained) DHF per Public Sector Vaccine Price per Dose_
100,000 Pop. $ 0.25 $ 0.50 $ 1.00 $ 1.50 36 $445 $506 $628 $690 72 $26 $56 $117 $148 108 CS CS CS CS
CS denotes cost saving (i.e., vaccination costs less than the status quo).
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3. Offer strategic advice across diseases: integration
• Control strategy simultaneously affects multiple diseases (e.g. vector that spreads multiple diseases)
• Setting for delivering one preventive or control strategy simultaneously serves as a vehicle for delivering many other strategies (The package services can be delivered for less than sum of components).
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4. Strengthen implementation (forecasting and efficiency)
• Forecast funding needs (e.g. budget for drugs)
• Compare efficiency across settings (e.g. local production versus importation)
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The future agenda• Aggregate across patients for debilitating
but non-fatal illnesses• Examine synergies among strategies (e.g.
vaccination and vector control)• Conduct economic evaluation of promising
control strategies–experimental designs–natural experiments
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Future economic work group?• Would entail cooperation among
epidemiology, economics, and operations
• Would need access to data and programs for study
• Would need strategic guidance on priorities
