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, France

2nd Conference of the AFHEASaly, March 16th, 2011

A multi country study

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• Introduction & background

• Objectives of MVI economic project

• The cost of illness multi-country study• Methodology• Analyses and types of outputs• Next steps

• Conclusion

• Acknowledgments

Outline

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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

Introduction

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• 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.

Background on RTS,S

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• 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

Answering efficiency & affordability

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• 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 socio-economics 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

Why a multi-country cost of illness study?

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• 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)

Methodology 1: sample selection

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• Health facilities• Exit 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 situation• All 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 costs• length of stay, health staff who treated the case• Outcome (death, sequelae…)

Methodology 2: study components

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• 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

Methodology 3: study components (2)

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Countries involved & Current statusCountry Partner StatusGhana 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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• 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. private

• Costs to health systems• Treatments and lab tests costs incurred by health facility• Staff costs estimated by malaria case (salaries, time…)

Perspectives of analyses and outputs

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• 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

Next steps

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• 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

Conclusion

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• 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

Acknowledgments