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. 2012 Mar 2:344:e608.
doi: 10.1136/bmj.e608.

Cost effectiveness of strategies to combat chronic obstructive pulmonary disease and asthma in sub-Saharan Africa and South East Asia: mathematical modelling study

Anderson E Stanciole  1 , Mónica Ortegón, Dan Chisholm, Jeremy A Lauer
Affiliations

Cost effectiveness of strategies to combat chronic obstructive pulmonary disease and asthma in sub-Saharan Africa and South East Asia: mathematical modelling study

Anderson E Stanciole et al. BMJ. .

Abstract

Objectives: To determine the population level costs, effects, and cost effectiveness of selected, individual based interventions to combat chronic obstructive pulmonary disease (COPD) and asthma in the context of low and middle income countries.

Design: Sectoral cost effectiveness analysis using a lifetime population model.

Setting: Two World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD).

Data sources: Disease rates and profiles were taken from the WHO Global Burden of Disease study; estimates of intervention effects and resource needs were drawn from clinical trials, observational studies, and treatment guidelines. Unit costs were taken from a WHO price database.

Main outcome measures: Cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005.

Results: In both regions low dose inhaled corticosteroids for mild persistent asthma was considered the most cost effective intervention, with average cost per DALY averted about $Int2500. The next best value strategies were influenza vaccine for COPD in Sear-D (incremental cost $Int4950 per DALY averted) and low dose inhaled corticosteroids plus long acting β agonists for moderate persistent asthma in Afr-E (incremental cost $Int9112 per DALY averted).

Conclusions: COPD is irreversible and progressive, and current treatment options produce relatively little gains relative to the cost. The treatment options available for asthma, however, generally decrease chronic respiratory disease burden at a relatively low cost.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

AES is a staff member of the World Bank; DC and JL are staff members of the WHO. The authors alone are responsible for the views expressed in this publication, and these do not necessarily represent the decisions, policy, or views of the organisations they work for.

Figures

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Fig 1 Cost effectiveness isoquants of interventions for chronic obstructive pulmonary disease (COPD) and asthma interventions (at 80% coverage) for sub-Saharan African sub-region Afr-E. See table 3 for explanation of intervention codes
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Fig 2 Cost effectivenes isoquants of chronic obstructive pulmonary disease (COPD) and asthma interventions (at 80% coverage) for South East Asian sub-region Sear-D. See table 3 for explanation of intervention codes
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Fig 3 Probabilistic uncertainty graph of interventions for chronic obstructive pulmonary disease (COPD) and asthma interventions (at 80% coverage) for sub-Saharan African sub-region Afr-E. See table 3 for explanation of intervention codes
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Fig 4 Probabilistic uncertainty graph of interventions for chronic obstructive pulmonary disease (COPD) and asthma interventions (at 80% coverage) for WHO South East Asia sub-region SearD. See table 3 for explanation of intervention codes
See this image and copyright information in PMC

References

    1. World Health Organization. The global burden of disease: 2004 update. WHO, 2008.
    1. Lopez AD, Shibuya K, Rao C, Mathers CD. Estimating the burden of COPD. Eur Respir J 2006;27:397-402. - PubMed
    1. Mannino D. Chronic obstructive pulmonary disease in 2025: where are we headed? Eur Respir J 2005;26:189. - PubMed
    1. Mannino D, Buist SA. Global burden of COPD: risk factors, prevalence, and future trends. Lancet 2007;370:765-73. - PubMed
    1. Chan Yeung M, Aït-Khaled N, White N, Ip MS, Tan WC. The burden and impact of COPD in Asia and Africa. Int J Tuberc Lung Dis 2004;8:2-14. - PubMed