Cost-Effectiveness Analysis of Combined Active and Passive versus Passive Leprosy Case Detection Alone in Thailand

Transcription

1 Cost-Effectiveness Analysis of Combined Active and Passive versus Passive Leprosy Case Detection Alone in Thailand Weena Primkaew Raj Pracha Samasai Institute Department of disease control, Thailand

2 Problems and Its Significance 2007: Prevalence rate = 0.17 / inhabitants. Delay in diagnosis New case with grade 2 disability not decline to 2007 has been between 11.4% and 11.5% 2

3 Proportion of grade 2 disability among newly detected cases: % YEAR 3

4 Problems and Its Significance Case finding is one of the core activities of leprosy elimination and control. Two method of case finding: - Active case detection method (ACD): Rapid Village Survey, Contact exam, School exam - Passive case detection method (PCD): Self reporting The budget is limited. 4

5 General Objective To identify the most cost-effectiveness strategy for new case detection of leprosy in non-endemic and endemic area of Thailand. 5

6 Specific Objectives 1) To calculate the total cost of each case detection method from health provider as well as consumer point of view. 2) To analyze outcomes in term of total number of new cases detected of each method. 3) To analyze the cost-effectiveness of case detection methods (combined ACD and PCD method compare to the PCD alone) according to the endemicity of leprosy. 6

7 Conceptual Framework Cost -Provider -Patient ACD+PCD Outcomes -No. of newly detected leprosy case Endemic area Cost / 1 case detected compare Non-endemic area Cost / 1 case detected Cost -Provider -Patient PCD alone Outcomes - No. of newly detected leprosy case 22 7

8 Cost (Baht) Conceptual Framework (cont.) Incremental cost analysis (ICA) No. of cases detected (case) ICA = PCD alone ACD PCD & PCD Activity PCD alone ACD & PCD Activity Cost of ACD+PCD Cost of PCD alone No. of cases detected from ACD+PCD No. of cases detected from PCD alone 8

9 Methodology Study Design: Retrospective descriptive study. Study Area: - There are 12 regions in Thailand. - Divided into 2 groups. Area No. of region Newly detected case Non- endemic area 7 1-5O cases Endemic area 4 >50 cases 9

10 Study population: Methodology (cont.) The 60 providers interviewed who responsibility the leprosy control program at regional, provincial, district level and health center. The total of newly detected cases in 2006 for selected areas is 51 cases. Interviewed 42 cases (6 cases went to other provinces, 3 cases died) 10

11 Exclusion criteria: Methodology (cont.) - patients which past history of leprosy are not included in this study : relapse, re-instate case. Sampling Technique: Stratified two stages sampling 11

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13 Data Collection and Calculation 1. Calculation of costs : Total costs for Provider Perspective Cost items Unit of measurement Source of data Recurrent Costs: -Personnel -Material supply -Training program -Social mobilization - RVS implementation Baht/year Baht/year Baht/year Baht/year Baht/year Secondary data Secondary data Secondary data Secondary data Secondary data 13

14 Data Collection and Calculation (cont.) Total Costs for Patient Side Category Unit of measurement Source of data Direct cost (patient) - Traveling cost Baht/year Primary data - Food cost Baht/year Primary data -Time cost Baht/year Primary data 14

15 Data Collection and Calculation (cont.) Total Costs for Patient Side (cont.) Category Unit of measurement Source of data Indirect cost (relative) - Traveling cost Baht/year Primary data - Food cost Baht/year Primary data -Time cost Baht/year Primary data 15

16 Data Collection and Calculation (cont.) 2. Cost-Effectiveness Analysis: Calculate by dividing the total cost of each case detection activities with total number of newly detected cases from each case detection activities. 16

17 Results and Discussions 1. Analyzing costs and effectiveness (Provider s perspective) 1.1 Calculation of costs for each method of case finding activities. Table1 Total costs of case finding activities for each area Non-endemic Area ACD&PCD Total costs (Baht) PCD alone DPCR 4 279, , DPCR 8 163, , DPCR , , Total 680, ,

18 Results and Discussions 1. Analyzing costs and effectiveness (Provider s perspective) 1.1 Calculation of costs for each method of case finding activities. Table1 Total costs of case finding activities for each area (cont.) Area Total costs (Baht) Endemic ACD&PCD PCD alone DPCR 5 203, , DPCR 6 159, , DPCR 7 185, , DPCR , ,

19 Results and Discussions 1.2 Calculation of cost-effectiveness for each method of case finding activities. (provider s perspective) Table 2 Cost-effectiveness of case finding activities for each region Area ACD&PCD PCD alone Non-end. C/E ratio (baht) No.of case C/E ratio (baht) No.of case DPCR 4 139, ,156 2 DPCR8 18, ,609 3 DPCR11 47, ,456 3 Total 42, ,

20 Results and Discussions 1.2 Calculation of cost-effectiveness for each method of case finding activities. (provider s perspective) Table 2 Cost-effectiveness of case finding activities for each region (cont.) Area ACD&PCD PCD alone Endemic C/E ratio (baht) No.of case C/E ratio (baht) No.of case DPCR 5 50, ,071 4 DPCR DPCR 7 23, ,786 3 DPCR 10 28, ,614 1 Total 39, ,

21 Results and Discussions 2. Analyzing costs and effectiveness (Patient s perspective) Table 3 Cost-effectiveness of case finding activities in each area Area Method Costs ( ) No. of patient interviewed C/E ( ) 21 Non-endemic DPCR 4 ACD&PCD 1, PCD alone DPCR 8 ACD&PCD PCD alone 1, DPCR 11 ACD&PCD 3, PCD alone 1, Total ACD&PCD 5, ,362 PCD alone 2, ,345

22 Endemic Results and Discussions 2. Analyzing costs and effectiveness (Patient s perspective) (cont.) Table 3 Cost-effectiveness of case finding activities in each area (cont.) Area Method Costs ( ) No. of patient interviewed C/E ( ) DPCR 5 DPCR 6 DPCR 7 DPCR 10 Total ACD&PCD PCD alone ACD&PCD PCD alone ACD&PCD PCD alone ACD&PCD PCD alone ACD&PCD PCD alone 60 2, , ,269 2,

23 Conclusions The total cost from provider perspective of ACD&PCD was 1,427,800 baht for founding the 35 leprosy newly detected cases (1 case: 40,794 baht) The total cost from provider perspective of PCD alone was 1,340,230 baht for founding the 16 leprosy newly detected cases (1 case: 83,764 baht) 23

24 Conclusions (cont.) In non-endemic area, the C/E ratio of PCD alone is 2.2 times higher than the C/E ratio of ACD&PCD. In endemic area, the C/E ratio of PCD alone is 1.9 times higher than the C/E ratio of ACD&PCD. Because the no. of newly detected cases in endemic areas > non-endemic areas. 24

25 Conclusions (cont.) The total cost from patient perspective In non-endemic areas, they are 2.2 times higher than in endemic area. The C/E ratio of ACD&PCD in non-endemic areas is 1,362 baht and in endemic areas is 232 baht. The C/E ratio of PCD alone in non-endemic areas is 1,345 baht and in endemic areas is 816 baht. The combined ACD&PCD method successfully detected more number of cases than PCD alone method. 25

26 Limitation of study Recall bias of the primary data from patient and provider side. The two compared methods were carried out under different setting. We can not measure intangible costs (stigma of leprosy). The study result is difficult to be generalized. Some data are still missing:- capital cost, purchased dates, value of equipment or building are not recorded. The cost incurred by national leprosy program to provide supervision and monitoring was not calculated in this study. 26

27 Policy implication This study could be used as a basic guideline for leprosy program manager, and policy maker to make a policy planning about leprosy control program. The combined ACD & PCD method should be given more priority. Therefore, the allocation of the budget for case finding activities should take endemicity of targeted areas into consideration. 27

28 Policy implication (cont.) The policy maker should use the solution provided in this study as reference information to conduct the social mobilization activities. If the social mobilization is carried out in all villages (100%) coverage, the cost will be higher than conducting only 50% or 75% of the all villages. But it should be kept in mind that the outcome of this activity is not only the no. of cases but also the leprosy awareness of the community. 28

29 I owe thanks to:- NLR that provided funding. Acknowledgements Dr. Chantal Herberholz, Prof. Pirom Kamolratanakul, and the others (thesis committee) Ms. Oraphin Mathew, Dr. Somchye Rungtrakulchai, Dr. Krisada Mahotarn, Mrs. Silatham Sermritthirong Leprosy related officers of DPCR, Provincial, District, staff of RPSI and the leprosy affected persons 29

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