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

dc.contributor.authorShepard, Donald S
dc.contributor.authorHalasa-Rappel, Yara A
dc.contributor.authorRowlands, Katharine R
dc.contributor.authorKulchyckyj, Maria
dc.contributor.authorBasaza, Robert K
dc.contributor.authorOtieno, Emmanuel D
dc.contributor.authorMutatina, Boniface
dc.contributor.authorKariuki, Simon
dc.contributor.authorMusange, Sabine F
dc.date.accessioned2024-02-14T21:05:19Z
dc.date.available2024-02-14T21:05:19Z
dc.date.issued2023-07-31
dc.identifier.citationShepard DS, Halasa-Rappel YA, Rowlands KR, Kulchyckyj M, Basaza RK, Otieno ED, Mutatina B, Kariuki S, Musange SF. Economic analysis of a new four-panel rapid screening test in antenatal care in Kenya, Rwanda, and Uganda. BMC Health Serv Res. 2023 Jul 31;23(1):815. doi: 10.1186/s12913-023-09775-z. PMID: 37525192; PMCID: PMC10391856.en_US
dc.identifier.eissn1472-6963
dc.identifier.doi10.1186/s12913-023-09775-zen_US
dc.identifier.pmid37525192
dc.identifier.urihttp://hdl.handle.net/20.500.14038/53059
dc.description.abstractBackground: We 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. Methods: We 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). Results: The 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. Conclusion: Though 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.en_US
dc.language.isoenen_US
dc.relation.ispartofBMC Health Services Researchen_US
dc.relation.urlhttps://doi.org/10.1186/s12913-023-09775-zen_US
dc.rights© The Author(s) 2023. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.en_US
dc.rightsAttribution 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectAntenatal careen_US
dc.subjectCost-effectivenessen_US
dc.subjectHIV/AIDSen_US
dc.subjectHepatitis Ben_US
dc.subjectKenyaen_US
dc.subjectMalariaen_US
dc.subjectRwandaen_US
dc.subjectSyphilisen_US
dc.subjectUgandaen_US
dc.titleEconomic analysis of a new four-panel rapid screening test in antenatal care in Kenya, Rwanda, and Ugandaen_US
dc.typeJournal Articleen_US
dc.source.journaltitleBMC health services research
dc.source.volume23
dc.source.issue1
dc.source.beginpage815
dc.source.endpage
dc.source.countryEngland
dc.identifier.journalBMC health services research
refterms.dateFOA2024-02-14T21:05:20Z
dc.contributor.departmentForHealth Consultingen_US


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© The Author(s) 2023. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Except where otherwise noted, this item's license is described as © The Author(s) 2023. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.