Cost-effectiveness of safe injection policies: Study rationale and proposed methodology

1. Cost-effectiveness of safe injection policies: Study rationale and proposed methodology Ulla Kou, WHO SIGN meeting in New Delhi August 2001

2. A future study • “A model to estimate the cost utility of safe and appropriate use of injection policies” • Funds for the model development have been donated by the US National Vaccine Programme Office (NUPO) through USAID • Participation from SIGN members most welcome

3. The questions a CE analysis will seek to answer • What are the net-costs of preventing an infection and/or saving a life from implementing safe injection policies? • What is the cost-effectiveness of safe injection policies compared to other health interventions?

4. The need for CE analysis of safe injection policies • Evidence based advocacy aimed at: • Ministries of Health • Ministries of Finance • Donors • International health community • As part of WHO’s ongoing work on global burden of disease estimates

5. Proposed method • Add cost data to the burden model • Compare the costs and effects of two scenarios: A: The “do nothing” scenario, in terms of injection frequency and safety B: Implement safe and appropriate injection practices From scenario A and B an incremental cost-effectiveness ratio can be calculated

6. Outcome measures • Costs per HBV, HCV and HIV infection prevented • Costs per death prevented • Costs per Disability Adjusted Life Year (DALY) gained A societal perspective will be taken

7. Estimating costs of the “do-nothing” scenario Data needed: • Costs per injection • Average treatment costs for a HBV, HBC and HIV case, from the perspective of the public health sector as well as the patient • Costs of premature death due to HBV, HBC and HIV, from the perspective of society

8. Estimating effects of the “do-nothing” scenario Data needed: • Unsafe injection indicators (as defined in the burden model) • Probability of transmission of HBV, HBC and HIV (as defined in the burden model) • Prevalence of HBV, HBC and HIV • DALY values for HBV, HBC and HIV

9. Estimating costs of the intervention scenario Data needed: • Costs per injection • Costs of the intervention, including safe injection equipment, waste management, behaviour change strategy, assessment, monitoring, etc. • Average treatment costs for a HBV, HBC and HIV case • Costs of premature death due to HBV, HBC and HIV

10. Estimating effects of the intervention scenario • Data as in the “do nothing” scenario, but with alternative estimates for the unsafe injection indicators

11. The perspectives

12. The work ahead • Formulation of TOR for economist by end of September (check SIGN web site) • Recruitment on 11 month contract in WHO • Construction of model and identification of data gaps • Data collection in selected countries • Publication of model and country examples • Publication of model on SIGN web site for easy use in different settings