Vaccines & Biologicals (V&B) Cost-effectiveness of safe injection policies: Study rationale and proposed methodology Ulla Kou, WHO SIGN meeting in New Delhi August 2001

Vaccines & Biologicals (V&B) 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

Vaccines & Biologicals (V&B) 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?

Vaccines & Biologicals (V&B) 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

Vaccines & Biologicals (V&B) 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

Vaccines & Biologicals (V&B) 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

Vaccines & Biologicals (V&B) 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

Vaccines & Biologicals (V&B) 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

Vaccines & Biologicals (V&B) 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

Vaccines & Biologicals (V&B) Estimating effects of the intervention scenario –Data as in the “do nothing” scenario, but with alternative estimates for the unsafe injection indicators

Vaccines & Biologicals (V&B) The perspectives

Vaccines & Biologicals (V&B) 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