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Biomedical subjects

Damian Walker

Publications and source records attributed to Damian Walker.

At least 19 recordsLinked to original sources
PubMed2006

Economics methods in Cochrane systematic reviews of health promotion and public health related interventions.

BACKGROUND: Provision of evidence on costs alongside evidence on the effects of interventions can enhance the relevance of systematic reviews to decision-making. However, patterns of use of economics methods alongside systematic review remain unclear. Reviews of evidence on the effects of interventions are published by both the Cochrane and Campbell Collaborations. Although it is not a requirement that Cochrane or Campbell Reviews should consider economic aspects of interventions, many do. This study aims to explore and describe approaches to incorporating economics methods in a selection of Cochrane systematic reviews in the area of health promotion and public health, to help inform development of methodological guidance on economics for reviewers. METHODS: The Cochrane Database of Systematic Reviews was searched using a search strategy for potential economic evaluation studies. We included current Cochrane reviews and review protocols retrieved using the search that are also identified as relevant to health promotion or public health topics. A reviewer extracted data which describe the economics components of included reviews. Extracted data were summarised in tables and analysed qualitatively. RESULTS: Twenty-one completed Cochrane reviews and seven review protocols met inclusion criteria. None incorporate formal economic evaluation methods. Ten completed reviews explicitly aim to incorporate economics studies and data. There is a lack of transparent reporting of methods underpinning the incorporation of economics studies and data. Some reviews are likely to exclude useful economics studies and data due to a failure to incorporate search strategies tailored to the retrieval of such data or use of key specialist databases, and application of inclusion criteria designed for effectiveness studies. CONCLUSION: There is a need for consistency and transparency in the reporting and conduct of the economics components of Cochrane reviews, as well as regular dialogue between Cochrane reviewers and economists to develop increased capacity for economic analyses alongside such reviews. Use of applicable economics methods in Cochrane reviews can help provide the international context within which economics data can be interpreted and assessed as a preliminary to full economic evaluation.

Clinical Protocols↗
PubMed2006

Economic evaluations of non-communicable disease interventions in developing countries: a critical review of the evidence base.

BACKGROUND: Demographic projections suggest a major increase in non-communicable disease (NCD) mortality over the next two decades in developing countries. In a climate of scarce resources, policy-makers need to know which interventions represent value for money. The prohibitive cost of performing multiple economic evaluations has generated interest in transferring the results of studies from one setting to another. This paper aims to bridge the gap in the current literature by critically evaluating the available published data on economic evaluations of NCD interventions in developing countries. METHODS: We identified and reviewed the methodological quality of 32 economic evaluations of NCD interventions in developing countries. Developing countries were defined according to the World Bank classification for low- and lower middle-income countries. We defined NCDs as the 12 categories listed in the 1993 World Bank report Investing in Health. English language literature was searched for the period January 1984 and January 2003 inclusive in Medline, Science Citation Index, HealthStar, NHS Economic Evaluation Database and Embase using medical subheading terms and free text searches. We then assessed the quality of studies according to a set of pre-defined technical criteria. RESULTS: We found that the quality of studies was poor and resource allocation decisions made by local and global policy-makers on the basis of this evidence could be misleading. Furthermore we have identified some clear gaps in the literature, particularly around injuries and strategies for tackling the consequences of the emerging tobacco epidemic. CONCLUSION: In the face of poor evidence the role of so-called generalised cost-effectiveness analyses has an important role to play in aiding public health decision-making at the global level. Further research is needed to investigates the causes of variation among cost, effects and cost-effectiveness data within and between settings. Such analyses still need to take a broad view, present data in a transparent manner and take account of local constraints.

Journal Article↗
PubMed2005

Introducing hepatitis B virus vaccine into the Expanded Programme on Immunization in Bangladesh: a proposed method to evaluate whether the existing infrastructure has the capacity.

To determine whether the existing Expanded Programme on Immunization (EPI) in Bangladesh has the capacity to introduce the hepatitis B virus (HBV) vaccine, this study was carried out in all the nine health facilities, which maintain a cold-chain, in Chandpur district of Bangladesh. The research, focusing specifically on cold-chain equipment, aimed at developing and applying an indicator of the use of cold-chain equipment. A structured questionnaire, developed and field-tested, was used for collecting information on cold-chain equipment and their use-rate. Data were used for estimating the resources needed to introduce the HBV vaccine and for increasing the coverage of measles and DPT vaccines. The findings of the study showed that the use-rate of cold-chain equipment in this district was low, suggesting that the district has sufficient spare capacity to introduce and sustain the storage of an increased quantity of vaccines. This paper suggests an approach to study capacity in relation to infrastructural facilities. By measuring the capacity of capital equipment, the study has illustrated that the measurement of resource-use rates provides useful information about the burden that a new vaccine places on the EPI.

Bangladesh↗
PubMed2004

Adolescent vaccination in the developing world: time for serious consideration?

The number of vaccinations and vaccine boosters that are becoming relevant to delivery among adolescents is growing. For sexually transmitted infections (STIs) in particular, such as HIV, vaccine delivery in this (pre-sexually active) age group is going to be an integral component of the strategy to control these diseases in the future. Currently, however, adolescent vaccination does not routinely occur because the traditional method of delivery is through secondary schools, and in developing countries school attendance has historically been low. But with school attendance growing rapidly throughout the developing world, the cost of vaccines falling over time, and an increasing number of current and future vaccines targeted at adolescents, it is an ideal opportunity to place this route of delivery on the national and international health agenda. Therefore, this paper examines the rationale for adolescent vaccination, looks at the success of other adolescent-targeted health care interventions, and finally, considers the challenges associated with future adolescent vaccination programmes in developing countries.

Adolescent↗
PubMed2004

Cost and unit cost calculations using step-down accounting.

There is paucity of unit cost data from low- and middle-income countries, although recent initiatives have emerged to help rectify this. The limited budgets assigned to health care facilities mean that health planners and managers must be able to account for the resources used in health facilities as well as use them efficiently. Step-down cost accounting (SDCA) offers a relatively simple method for generating cost and unit cost data at the facility level. However, to the best of our knowledge, there is a lack of clear and concise guidance on how to undertake SDCA. Therefore, this paper, using a worked example, illustrates the different steps involved to generate cost and unit costs for a small hospital.

Accounting↗
PubMed2004

Are economic evaluations of vaccines useful to decision-makers? Case study of Haemophilus influenzae type b vaccines.

BACKGROUND: In concert with efforts to increase global provision, economic evaluations of newer and relatively costly vaccines have proliferated in the medical literature. The extent to which existing vaccine evaluations are useful to decision makers is not clear. We conducted a systematic review of published economic evaluations of conjugate Haemophilus influenzae type b (Hib) vaccine, anticipating that their usefulness to past and present decision makers would be limited by the quality of the analyses and by the extent to which the results were transferable to other settings. METHODS: We systematically identified economic evaluations of conjugate Hib vaccine. We appraised their quality according to a customized checklist and assessed the extent of and reasons for variability of the results. RESULTS: Quality assessment of the available economic evaluations disclosed a number of shortcomings, including the failure across all models to derive systematic estimates of vaccine efficacy as well as a lack of transparency in the costing of Hib disease treatment. Wide variations in results appeared to be caused primarily by epidemiologic and health system differences between settings and secondarily to methodologic differences between models. The generalizability of model results appeared low. CONCLUSIONS: There is scope for improving the overall quality of economic evaluations of Hib vaccination. Relevance to decision makers may also be increased by addressing local budget constraints and vaccine price. There is a need to better understand the decision process, particularly at the national level, to ensure the role of future economic evaluations as important decision tools in the implementation of new vaccines.

Australia↗
PubMed2004

The cost-effectiveness of HIV preventive measures among injecting drug users in Svetlogorsk, Belarus.

AIM: To undertake a cost-effectiveness analysis of a harm reduction and HIV prevention project for injecting drug users (IDUs) in Eastern Europe. Economic evaluation methods were adapted to consider the effect of an 8-month financing gap that negatively impacted on project implementation. DESIGN: Financial and economic costs of implementing the intervention were analysed retrospectively. The data were also modelled to estimate the costs of a fully functioning project. Estimates of the intervention impact on sexual and drug injecting behaviour were obtained from existing pre- and post-intervention behavioural surveys of IDUs. A dynamic mathematical model was used to translate these changes into estimates of HIV infections averted among IDUs and their sexual partners. Projections of the potential effect of the shortfall in funding on the impact and cost-effectiveness of the intervention were made. SETTING: Svetlogorsk, Belarus, where in 1997 the IDU HIV prevalence was 74%. FINDINGS: The intervention averted 176 HIV infections (95% CI 60-270) with a cost-effectiveness of 359 dollars per HIV infection averted (95% CI 234-1054 dollars). Without the 2311 dollars reduction (7%) in financing, the estimated cost-effectiveness ratio of the project would have been 11% lower. The costing methods used to measure donated mass media can substantially influence cost and cost-effectiveness estimates. CONCLUSIONS: Harm reduction activities among IDUs can be cost-effective, even when IDU HIV prevalence and incidence is high. Relatively small shortfalls in funding reduce impact and cost-effectiveness. Increased and consistent allocation of resources to harm reduction projects could significantly reduce the pace of the HIV epidemic in Eastern Europe.

Cost-Benefit Analysis↗
PubMed2004

Cost of delivering child immunization services in urban Bangladesh: a study based on facility-level surveys.

This facility-based study estimated the costs of providing child immunization services in Dhaka, Bangladesh, from the perspective of healthcare providers. About a quarter of all immunization (EPI) delivery sites in Dhaka city were surveyed during 1999. The EPI services in urban Dhaka are delivered through a partnership of the Government of Bangladesh (GoB) and non-governmental organizations (NGOs). About 77% of the EPI delivery sites in Dhaka were under the management of NGOs, and 62% of all vaccinations were provided through these sites. The outreach facilities (both GoB and NGO) provided immunization services at a much lower cost than the permanent static facilities. The average cost per measles-vaccinated child (MVC), an indirect measure of number of children fully immunized (FIC-the number of children immunized by first year of life), was 11.61 U.S. dollars. If all the immunization doses delivered by the facilities were administered to children who were supposed to be immunized (FVC), the cost per child would have been 6.91 U.S. dollars. The wide gap between the cost per MVC and the cost per FVC implies that the cost of immunizing children can be reduced significantly through better targeting of children. The incremental cost of adding new services or interventions with current EPI was quite low, not significantly higher than the actual cost of new vaccines or drugs to be added. NGOs in Dhaka mobilized about 15,000 U.S. dollars from the local community to support the immunization activities. Involving local community with EPI activities not only will improve the sustainability of the programme but will also increase the immunization coverage.

Bangladesh↗
PubMed2003

The cost effectiveness of universal antenatal screening for HIV in New Zealand.

OBJECTIVE: To model the incremental costs and benefits of a universal antenatal HIV screening programme in New Zealand (NZ). DESIGN: Cost effectiveness analysis, including only health service costs, using secondary data sources and expert opinion. Uncertainty assessed in multi-way sensitivity analyses. SETTING: The NZ Health Care System. SUBJECTS: Antenatal population of NZ. INTERVENTION: Universal antenatal HIV screening programme. MAIN OUTCOME MEASURES: Incremental cost per true-positive HIV case detected in mothers; incremental cost per HIV case avoided in babies; and incremental cost per discounted life-year gained, for mothers and babies, due to screening. RESULTS: Using base case values the application of universal screening would cost an additional $NZ 723 607 ($US 307 917) and would lead to the identification of an additional 6.25 true-positive women. After terminations have been excluded, the screening programme would detect five HIV exposed babies. There would be 1.15 avoided cases of HIV infection in babies and a net gain of 41.97 discounted life-years, for mothers and babies combined. The cost per incremental HIV-positive woman detected was $NZ 115 859 ($US 49 301), HIV infected baby avoided $NZ 629 669 ($US 267 944) and discounted life-year gained $NZ 17 241 ($US 7336). CONCLUSION: The discounted cost per life gained in NZ compares favourably to estimates reported in studies of similar interventions in other developed countries and other health care interventions in NZ. The decision of whether to implement universal screening in NZ would be clarified if the prevalence of antenatal HIV infection was known and policy makers identified their willingness to pay for an additional life-year gained.

Cost-Benefit Analysis↗
PubMed2003

Are vaccination sites in Bangladesh scale efficient?

OBJECTIVES: The overall aim of this study is to discern whether and to what degree vaccination sites exhibit constant returns to scale. METHODS: Data Envelopment Analysis is used to compare all the facilities in the sample in terms of input costs used to produce multiple outputs. The application considers the Expanded Program on Immunization (EPI), which operated in Dhaka City, Bangladesh, during 1999. RESULTS: A preponderance of EPI sites were determined to be operating at increasing returns to scale. CONCLUSIONS: Our findings question the applicability of cost-effectiveness analyses that assume constant returns to scale.

Bangladesh↗
PubMed2003

Surviving the impact of HIV-related illness in the Zambian business sector.

The HIV epidemic in sub-Saharan Africa represents an obstacle to productive employment and economic development. Employers in the region are experiencing severe staff shortages, reduced productivity, and increased costs because of protracted ill health and death among their workforce. The scale of the problem has not been fully estimated and the extent to which it could be ameliorated by control measures including effective treatment of opportunistic infections is not well known. Employers and employees (n = 108) in seven Zambian firms were interviewed to assess direct and indirect costs of illness to the firms. Information was collected on diagnosis and treatment received, duration of illness, time off, and strategies adopted to compensate for absent workers using a combination of questionnaires, structured interviews and focus group discussions. The main causes of ill health were tuberculosis (TB) (46.8%), diarrhea (12.9%), and sexually transmitted diseases (STDs; 5.8%). Annual treatment costs to the firm ranged from Zambia Kwacha (K) 60,000 to 405,000 per person treated. Other firm costs included productivity losses because of ill health, paid sick leave, the cost of employee replacement, and funerals. Employees incurred K 67,773 on average per illness episode. The most common causes of ill health were those most frequently associated with HIV. They can be easily but were often ineffectively treated. Improving disease management would thus reduce wastage and costs both to employer and employee. The extent of the impact in these firms shows the need for the private sector to adopt a stronger role in prevention and care. Further research is required to assess what recommended treatment options might be, how they could be financed, and the extent of the economic impact of HIV on firms. This would foster the development of more appropriate responses to the epidemic in Zambia and the region as a whole.

AIDS-Related Opportunistic Infections↗
PubMed2003

Cost and cost-effectiveness of HIV/AIDS prevention strategies in developing countries: is there an evidence base?

Many donors and countries are striving to respond to the HIV/AIDS epidemic by implementing prevention programmes. However, the resources available for providing these activities relative to needs are limited. Hence, decision-makers must choose among various types of interventions. Cost information, both measures of cost and cost-effectiveness, serves as a critical input into the processes of setting priorities and allocating resources efficiently. This paper reviews the cost and cost-effectiveness evidence base of HIV/AIDS prevention programmes in low- and middle-income countries (LMICs). None of the studies found have complete cost data for a full range of HIV/AIDS prevention programmes in any one country. However, the range of studies highlight the relative emphasis of different types of HIV/AIDS prevention strategies by region, reflecting the various modes of transmission and hence, to a certain extent, the stage of the epidemic. The costing methods applied and results obtained in this review give rise to questions of reliability, validity and transparency. First, not all of the studies report the methods used to calculate the costs, and/or do not provide all the necessary data inputs such that recalculation of the results is possible. Secondly, methods that are documented vary widely, rendering different studies, even within the same country and programme setting, largely incomparable. Finally, even with consistent and replicable measurement, the results as presented are generally not comparable because of the lack of a common outcome measure. Therefore, the extent to which the available cost and cost-effectiveness evidence base on HIV/AIDS prevention strategies can provide guidance to decision-makers is limited, and there is an urgent need for the generation of this knowledge for planning and decision-making.

AIDS Serodiagnosis↗
PubMed2003

The economics of TB control in developing countries.

Tuberculosis is one of the world's biggest killers and the burden is skewed towards developing countries, where the relative share of this disease is largest. This has much to do with poor living conditions and less developed public health systems. Nevertheless, even with these factors taken into account, the mortality from this disease is still unjustifiably high given the fact that it is treatable in the vast majority of cases with relatively inexpensive drugs. There are three main reasons for this situation: a low propensity to seek healthcare when sick; poor diagnosis upon seeking care; and high levels of non-compliance with treatment when diagnosed. Taken in combination, this means that of those who seek care, some get appropriate diagnosis at their first contact, while many do not. Unfortunately, not all of those who are diagnosed actually begin treatment and of those who do, a smaller percentage actually complete it. This article will look at each of these issues, and in particular their costs, in turn, and suggest areas in which economics can help to develop solutions to them.

Antitubercular Agents↗
PubMed2002

Cost data for individual patients included in clinical studies: no amount of statistical analysis can compensate for inadequate costing methods.

This work examines the quality of the cost methods used to derive patient level costs in 45 economic evaluations conducted alongside randomised controlled trials. The perspective of the cost analysis, the methods used to determine quantities and values of resources and how the cost data were reported are examined. The reported costing methods were found to be of poor quality, highlighting the need for greater rigour. Researchers to date appear more concerned with whether cost data have been subjected to the appropriate statistical analysis. For the results of clinical studies to be valid both cost methods and the methods used for the statistical analysis of cost data should be of a high quality.

Cost-Benefit Analysis↗
PubMed2002

Allowing for differential timing in cost analyses: discounting and annualization.

There are differences in timing related to when costs of certain inputs are incurred and when they are used over the lifetime of a programme. This paper looks at the issues related to the comparison of cost data over time focusing on discounting and annualization adjustments, which are used by economists to calculate financial and economic costs. The process of discounting is used to deal with the notion of time preference. Time preference implies that future costs are worth less, and hence discounted more, to reflect individual and societal preferences to have resources and money now rather than in the future. While discounting is appropriate in many situations, it is also useful to compute an annual equivalent cost when recurrent costs of an intervention are incurred, or are expected to be incurred, in subsequent years. This approach has the added benefit of illustrating how capital items are actually used during the lifetime of an intervention. This paper presents methods to both discount and annualize costs, and discusses rules-of-thumb to decide when to make these adjustments.

Accounting↗
PubMed2002

An economic analysis of midwifery training programmes in South Kalimantan, Indonesia.

In order to improve the knowledge and skills of midwives at health facilities and those based in villages in South Kalimantan, Indonesia, three in-service training programmes were carried out during 1995-98. A scheme used for both facility and village midwives included training at training centres, peer review and continuing education. One restricted to village midwives involved an internship programme in district hospitals. The incremental cost-effectiveness of these programmes was assessed from the standpoint of the health care provider. It was estimated that the first scheme could be expanded to increase the number of competent midwives based in facilities and villages in South Kalimantan by 1% at incremental costs of US$ 764.6 and US$ 1175.7 respectively, and that replication beyond South Kalimantan could increase the number of competent midwives based in facilities and villages by 1% at incremental costs of US$ 1225.5 and US$ 1786.4 per midwife respectively. It was also estimated that the number of competent village midwives could be increased by 1% at an incremental cost of US$ 898.1 per intern if replicated elsewhere, and at a cost of US$ 146.2 per intern for expanding the scheme in South Kalimantan. It was not clear whether the training programmes were more or less cost-effective than other safe motherhood interventions because the nature of the outcome measures hindered comparison.

Clinical Competence↗