Transcript AFHEA Conference presentation_PATH MVI_ Version March 16thx

Estimating the economic burden of malaria in
Sub-Saharan Africa : a first step towards the
cost-effectiveness of malaria vaccine
A multi country study
Dr. Alex Adjagba, MD. MSc
Health Economics & Policy Officer
The PATH Malaria Vaccine Initiative,
Ferney-Voltaire, France
2nd Conference of the AFHEA
Saly, March 16th, 2011
Outline
• Introduction & background
• Objectives of MVI economic project
• The cost of illness multi-country study
• Methodology
• Analyses and types of outputs
• Next steps
• Conclusion
• Acknowledgments
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Introduction
PATH MVI mission
• To accelerate the development of malaria vaccines
and ensure their availability and accessibility in the
developing world
Health economics project
• Aim to support the world’s clinically most advanced
vaccine candidate, the GSK’s RTS,S
• Involves working with researchers at international
(JHU and Swiss TPHI) and country level
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Background on RTS,S
• Ongoing phase 3 clinical trials in 7 countries
in sub-Saharan Africa (Burkina Faso, Gabon,
Ghana, Kenya, Mozambique, Malawi and
Tanzania)
• Over 15,000 infants and children enrolled
• Initial data from the trial will be available this
fall, with more to follow over the next few
years
• WHO recommendation not expected before
2015.
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Answering efficiency & affordability
• Is RTS,S added to current control measures
• A cost effective package? (CEA)
• Affordable for countries in the context of their current
health budgets? (budget impact analysis)
• Will be used to support decisions at:
• WHO requires to make a recommendation on
vaccine use
• Funding partners to prioritize countries’ application
• Countries to assess their specific environment
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Why a multi-country cost of illness study?
• Complement health burden data
• Estimate the economic impact of malaria in terms of
costs to households and health systems in sub-Saharan
Africa
• Identify who bears the costs of illness by socioeconomics groups
• Capture the diversity in economic burden
• Due to differences in epidemiology, seasonality, health
systems and malaria programs performances, economic
development
• Comparability of country data
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Methodology 1: sample selection
• Exclusion criteria
• All patients enrolled in the RTS,S clinical trials
• Inclusion criteria
• Patients under 5 years old with a clinical diagnosis of
malaria with subsequent laboratory confirmation,
where possible and their parents (or accompanying
responsible persons)
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Methodology 2: study components
• Health facilities
• Exit interviews of outpatient (OPD) and inpatient (IPD)
departments’ attendants
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costs of consultation,
treatment & tests costs ,
transportation costs from home to health facility,
household socio-economic situation
All costs spent before arriving to the study health center
• Records review: both retrospectively and prospectively
in OPD & IPD (seasonality aspect)
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diagnosis, disease history, confirmation tests,
treatment and drug costs
length of stay, health staff who treated the case
Outcome (death, sequelae…)
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Methodology 3: study components (2)
• Health providers’ interviews
• What they should do: national guidelines
• What they say they do: treatment given
• What they actually do: patient card/record
• Households’ survey
• 500 households with children under 5 years old
• Costs of malaria treatment in the last 2 weeks before study
(direct & indirect – including lost wages, origin of funds,
payers)
• Prevention costs
• Personal assets and household’s amenities
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Countries involved & Current status
Country
Partner
Status
Ghana pilot
Institute of Statistical
Social Sciences ,
(ISSER)
Completed in
December 2009
Ghana full study
ISSER
Completed October
2010
Burkina Faso roll-out
Institute of Research in
Social Sciences
Completed in
November 2010
Uganda roll-out
Makerere University,
Uganda
Start planned April
2011
Nigeria roll out
Health Policy research
Group at University of
Enugu Campus
Start planned April
2011
Additional countries
To be identified
June 2011
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Perspectives of analyses and outputs
• Costs to household (simple or severe malaria)
• direct medical costs (medications, diagnostics…)
• direct non-medical costs (transportation, accommodation..)
• indirect costs (loss of productivity due to care seeking)
• socio-economic distribution of malaria burden
• factors associated to each level of out-of-pocket expenses
Sub-analyses by confirmed vs. non confirmed cases;
insured patients vs. uninsured; public vs. private
• Costs to health systems
• Treatments and lab tests costs incurred by health facility
• Staff costs estimated by malaria case (salaries, time…)
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Next steps
• Roll-out the study in remaining countries
• Disseminate results
• Use data collected in the STPHI transmission-based
model to produce cost-effectiveness estimates of
RTS,S
• Release those estimates paced with release of
RTS,S vaccine phase 3 efficacy initial results
• Update the estimates regularly to reflect further
releases of vaccine efficacy data
• Data collected made available in a public database
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Conclusion
• MVI candidate vaccine against malaria will be
used in the context of existing control measures
• MVI intends to release cost-effectiveness
estimates of the vaccine and other economic
estimates to support policy decision
• MVI and its partners designed this multi-country
study to capture as much as possible malaria
economic burden, as a critical input in the
estimation of CEA
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Acknowledgments
• To colleagues involved at PATH Malaria
Vaccine Initiative
• To all partners at JHU, STPHI, and countries’
research institutions
• In particular to Drs Chris Atim and Damian
Walker
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