Economic analysis of a new four-panel rapid screening test in antenatal care in Kenya, Rwanda, and Uganda

BMC Health Services Research

Research

Emmanuel D Otieno¹  Simon Kariuki²  Boniface Mutatina³  Donald S Shepard⁴  Maria Kulchyckyj⁴  Katharine R Rowlands⁴  Yara A Halasa-Rappel⁵  Robert K Basaza⁶  Sabine F Musange⁷ 

[1] Bugema University, Bugema, Uganda;Kenya Medical Research Institute, Kisian, Kenya;Makerere University School of Medicine, Kampala, Uganda;The Heller School for Social Policy & Management, Brandeis University, 02454-9110, Waltham, MA, USA;The Heller School for Social Policy & Management, Brandeis University, 02454-9110, Waltham, MA, USA;Commonwealth Medicine, University of Massachusetts Medical School, Worcester, MA, USA;Uganda Christian University, Mukono, Uganda;University of Rwanda, Kigali, Rwanda;

关键词: Cost-effectiveness;    Antenatal care;    Hepatitis B;    HIV/AIDS;    Malaria;    Syphilis;    Kenya;    Rwanda;    Uganda;   

DOI  :  10.1186/s12913-023-09775-z

 received in 2022-07-29, accepted in 2023-07-03,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundWe performed an economic analysis of a new technology used in antenatal care (ANC) clinics, the ANC panel. Introduced in 2019–2020 in five Rwandan districts, the ANC panel screens for four infections [hepatitis B virus (HBV), human immunodeficiency virus (HIV), malaria, and syphilis] using blood from a single fingerstick. It increases the scope and sensitivity of screening over conventional testing.MethodsWe developed and applied an Excel-based economic and epidemiologic model to perform cost-effectiveness and cost-benefit analyses of this technology in Kenya, Rwanda, and Uganda. Costs include the ANC panel itself, its administration, and follow-up treatment. Effectiveness models predicted impacts on maternal and infant mortality and other outcomes. Key parameters are the baseline prevalence of each infection and the effectiveness of early treatment using observations from the Rwanda pilot, national and international literature, and expert opinion. For each parameter, we found the best estimate (with 95% confidence bound).ResultsThe ANC panel averted 92 (69–115) disability-adjusted life years (DALYs) per 1,000 pregnant women in ANC in Kenya, 54 (52–57) in Rwanda, and 258 (156–360) in Uganda. Net healthcare costs per woman ranged from $0.53 ($0.02-$4.21) in Kenya, $1.77 ($1.23-$5.60) in Rwanda, and negative $5.01 (-$6.45 to $0.48) in Uganda. Incremental cost-effectiveness ratios (ICERs) in dollars per DALY averted were $5.76 (-$3.50-$11.13) in Kenya, $32.62 ($17.54-$46.70) in Rwanda, and negative $19.40 (-$24.18 to -$15.42) in Uganda. Benefit-cost ratios were $17.48 ($15.90-$23.71) in Kenya, $6.20 ($5.91-$6.45) in Rwanda, and $25.36 ($16.88-$33.14) in Uganda. All results appear very favorable and cost-saving in Uganda.ConclusionThough subject to uncertainty, even our lowest estimates were still favorable. By combining field data and literature, the ANC model could be applied to other countries.

【 授权许可】

CC BY   
© The Author(s) 2023

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