Dr. Alex Adjagba, MD . MSc Health Economics & Policy Officer

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Estimating the economic burden of malaria in Sub-Saharan Africa : a first step towards the cost-effectiveness of malaria vaccine . Dr. Alex Adjagba, MD . MSc Health Economics & Policy Officer The PATH Malaria Vaccine Initiative, Ferney-Voltaire, France. 2 nd Conference of the AFHEA. - PowerPoint PPT Presentation

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Estimating the economic burden of malaria in Sub-Saharan Africa : a first step towards the cost-effectiveness of malaria vaccine Dr. Alex Adjagba, MD. MScHealth Economics & Policy OfficerThe PATH Malaria Vaccine Initiative, Ferney-Voltaire, France2nd Conference of the AFHEASaly, March 16th, 2011A multi country study1Introduction & backgroundObjectives of MVI economic projectThe cost of illness multi-country studyMethodologyAnalyses and types of outputsNext stepsConclusion Acknowledgments Outline#PATH MVI missionTo accelerate the development of malaria vaccines and ensure their availability and accessibility in the developing worldHealth economics project Aim to support the worlds clinically most advanced vaccine candidate, the GSKs RTS,SInvolves working with researchers at international (JHU and Swiss TPHI) and country level

Introduction#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 enrolledInitial data from the trial will be available this fall, with more to follow over the next few yearsWHO recommendation not expected before 2015.

Background on RTS,S#Is RTS,S added to current control measuresA 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 useFunding partners to prioritize countries application Countries to assess their specific environment

Answering efficiency & affordability #Complement health burden dataEstimate the economic impact of malaria in terms of costs to households and health systems in sub-Saharan AfricaIdentify who bears the costs of illness by socio-economics groupsCapture the diversity in economic burdenDue to differences in epidemiology, seasonality, health systems and malaria programs performances, economic developmentComparability of country data Why a multi-country cost of illness study? #Exclusion criteriaAll patients enrolled in the RTS,S clinical trialsInclusion criteriaPatients under 5 years old with a clinical diagnosis of malaria with subsequent laboratory confirmation, where possible and their parents (or accompanying responsible persons)

Methodology 1: sample selection #When the country is also a RTSS clinical trials country, the HE site is as much as possible different from the trial site. However, Only 2 countries so far are also clinical trial countries.7Health facilitiesExit interviews of outpatient (OPD) and inpatient (IPD) departments attendants costs of consultation, treatment & tests costs ,transportation costs from home to health facility, household socio-economic situationAll costs spent before arriving to the study health center Records review: both retrospectively and prospectively in OPD & IPD (seasonality aspect)diagnosis, disease history, confirmation tests, treatment and drug costslength of stay, health staff who treated the caseOutcome (death, sequelae)

Methodology 2: study components#Health providers interviewsWhat they should do: national guidelinesWhat they say they do: treatment givenWhat they actually do: patient card/recordHouseholds survey500 households with children under 5 years oldCosts of malaria treatment in the last 2 weeks before study (direct & indirect including lost wages, origin of funds, payers)Prevention costsPersonal assets and households amenities

Methodology 3: study components (2)#Countries involved & Current statusCountryPartnerStatusGhana pilotInstitute of Statistical Social Sciences , (ISSER)Completed in December 2009Ghana full studyISSERCompleted October 2010Burkina Faso roll-outInstitute of Research in Social Sciences Completed in November 2010Uganda roll-outMakerere University, Uganda Start planned April 2011Nigeria roll outHealth Policy research Group at University of Enugu Campus Start planned April 2011Additional countriesTo be identifiedJune 2011#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 expensesSub-analyses by confirmed vs. non confirmed cases; insured patients vs. uninsured; public vs. privateCosts to health systemsTreatments and lab tests costs incurred by health facilityStaff costs estimated by malaria case (salaries, time)

Perspectives of analyses and outputs#Roll-out the study in remaining countriesDisseminate results Use data collected in the STPHI transmission-based model to produce cost-effectiveness estimates of RTS,SRelease those estimates paced with release of RTS,S vaccine phase 3 efficacy initial resultsUpdate the estimates regularly to reflect further releases of vaccine efficacy dataData collected made available in a public databaseNext steps#MVI candidate vaccine against malaria will be used in the context of existing control measuresMVI intends to release cost-effectiveness estimates of the vaccine and other economic estimates to support policy decisionMVI 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 CEAConclusion#To colleagues involved at PATH Malaria Vaccine InitiativeTo all partners at JHU, STPHI, and countries research institutionsIn particular to Drs Chris Atim and Damian Walker

Acknowledgments #