Cost-effectiveness of a trap to capture the dengue adult vector in the context of the Public Health System in Brazil. Fabiana Floriano.
Cost-effectiveness of a trap tocapture the dengue adult vector in the context of the Public Health System in BrazilAuthors: Fabiana Raynal Floriano; Luis Eugenio Portela; Sebastião Loureiro;Martha Teixeira; Gimena M. Santos; Vanessa C.G.S. Morato; Maria da GlóriaTeixeira; Patrícia Barber; Naomar de Almeida Filho
Figure 2: Dengue incidence between 2001 and 2011 in Salvador, Bahia and Brazil. IntroductionFigure 1: Distribution of Dengue around the world, 2005. Source: http://www2.datasus.gov.br/DATASUS/index.phpSource: http://www.cdc.gov/ncidod/dvbid/dengue/map-distribution-2005.htm
Introduction Dengue’s impact on health services, society and country’s economy. National Dengue Control Plan (PNCD) (Ministry of Health, 2002). Strategies to eliminate the Aedes aegypti with controversial efficacy new technologies are being developed and applied. Mosquitrap - letal (Intelligent Monitoring System) Source: http://www.ecovec.com/ midengue.php
Objective To estimate the cost-effectiveness of: Trap to capture the dengue adult vector+ Usual program (Intervention area) Usual program of dengue control (Control area).
Materials and Method Time horizon: 2011; Public Health System perspective: direct medical costs Population: children aged 0-14 years Epidemiological indicators: incidence; percentage distribution of dengue according to dengue severity. Trap Effectiveness measure: Reduction of the dengue incidence
Materials and Method - CostsHealth Care Cost All stages of the disease progression (MH, 2011) Direct medical costs: diagnostic tests; drugs; service: professional fees and hospitalization
Materials and Method - CostsHealth Care Cost All stages of the disease progression (MH, 2011) Direct medical costs: diagnostic tests; drugs; service: professional fees and hospitalizationTechnology Cost 3,232 traps deployment service monitoring and maintenance services: materials and training
Materials and Method - CostsHealth Care Cost All stages of the disease progression (MH, 2011) Direct medical costs: diagnostic tests; drugs; service: professional fees and hospitalizationTechnology Cost 3,232 traps deployment service monitoring and maintenance services: materials and trainingTotal Cost Control Area: Health Care Cost Intervention Area: Health Care Cost + Technology Cost
Materials and MethodEffectiveness Prevented dengue casesCost-Effectiveness Decision tree analytical modelSensitivity Analysis Effectiveness: highest and lowest dengue incidence, in the last five years, in Salvador
ResultsTable 1: Total cost (USD) of dengue treatment, according to riskclassification, Salvador, Bahia, Brazil, 2011.Costs of Health Care Group A (%) Group B (%) Group C (%) Group D (%)Direct medical costs Diagnostic tests 201.12 (86.67) 487.93 (90.12) 3,478.98(58.37) 4,911.45 (53.36) Professional fees 11.78 (5.07) 27.26 (5.04) 2,445.69 (41.04) 4,030.96 (43.79)and Hospitalization Drugs 19.17 (8.26) 26.20 (4.84) 35.13 (0.59) 262.65 (2.85)Total Cost of Treatment 232.07 (100) 541.40 (100) 5,959.79 (100) 9,205.06 (100)
ResultsTable 2: Dengue cases, total cost and cost average case (USD), in theintervention and control areas, Salvador, Bahia, Brazil, 2011. Difference BetweenItens Intervention Area Control Area AreasIncidence 12.73% 14.38% -1.65Dengue Case 69,533 78,545 -9,012Treatment Cost 32,773,670.58 37,021,632.60 - 4,247,962.02Technology Cost 2,770,471.25 0.00 2,770,471.25Total Cost 35,544,141.83 37,021,632.60 - 1,477,490.77Cost Average Case 511.19 471.34 39.85
ResultsTable 3: Cost-Effectiveness (C/E), Incremental Cost-Effectiveness Ratio(ICER) and Sensitivity Analysis of control and interventionareas, Salvador, Bahia, Brazil, 2011. Cost Effectiveness EffectivenessAreas C/E Cost ICER (C) (E) (Prevented Cases) Intervention 35,544,141.83 69,533 511.19 - 1,477,490.76 -9,012 163.94 Control 37,021,632.60 78,545 471.34Sensitivity Analysis Highest Incidence Intervention 57,118,639.83 115,305 495.37 - 4,283,720.22 -14,966 286.23 Control 61,402,360.04 130,217 471.54 Lowest Incidence Intervention 8,357,184.93 11,853 705.07 2,023,859.75 -1,584 -1,277.68 Control 6,333,325.19 13,437 471.34
Conclusion Trap was effective Control area was dominated However, the sensitivity analysis showed that the ICER varied according to the population’s disease incidence Health managers must consider dengue incidence, before incorporating the trap
Bibliographical References1. BRASIL. Ministério da Saúde. Banco de Dados do Sistema Único deSaúde – DATASUS. http://www2.datasus.gov.br/DATASUS/index.php.2. BRASIL. Ministério da Saúde. Programa Nacional de Controle daDengue. MS, FUNASA. Brasília: Ministério da Saúde, 2002. 34p.3. SIGTAP. http://sigtap.datasus.gov.br/tabela-unificada/app/sec/inicio.jsp.4. Banco de Preços do Ministério da Saúde.http://bps.saude.gov.br/login.cfm.5. BRASIL. Ministério da Saúde. Dengue: diagnóstico e manejo clínico:criança. MS, Secretaria de Vigilância em Saúde, Departamento deVigilância Epidemiológica. – Brasília: Ministério da Saúde, 2011. 52p.6. BRASIL. Instituto Brasileiro de Geografia e Estatística – IBGE.http://www.ibge.gov.br/home/.7. BRASIL. Banco Central. Taxa de Câmbio.http://www4.bcb.gov.br/pec/conversao/conversao.asp.8. ECOVEC. M.I. Dengue. http://www.ecovec.com/midengue.php.
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