Fraser Heather L, Feldhaus Isabelle, Edoka Ijeoma P, Wade Alisha N, Kohli-Lynch Ciaran N, Hofman Karen, Verguet Stéphane
Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building (Level 3), 90 Byres Road, United Kingdom.
SA MRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Johannesburg 2193, South Africa.
Health Policy Plan. 2024 Mar 12;39(3):253-267. doi: 10.1093/heapol/czae001.
The rising prevalence of diabetes in South Africa (SA), coupled with significant levels of unmet need for diagnosis and treatment, results in high rates of diabetes-associated complications. Income status is a determinant of utilization of diagnosis and treatment services, with transport costs and loss of wages being key barriers to care. A conditional cash transfer (CCT) programme, targeted to compensate for such costs, may improve service utilization. We applied extended cost-effectiveness analysis (ECEA) methods and used a Markov model to compare the costs, health benefits and financial risk protection (FRP) attributes of a CCT programme. A population was simulated, drawing from SA-specific data, which transitioned yearly through various health states, based on specific probabilities obtained from local data, over a 45-year time horizon. Costs and disability-adjusted life years (DALYs) were applied to each health state. Three CCT programme strategies were simulated and compared to a 'no programme' scenario: (1) covering diagnosis services only; (2) covering treatment services only; (3) covering both diagnosis and treatment services. Cost-effectiveness was reported as incremental net monetary benefit (INMB) using a cost-effectiveness threshold of USD3015 per DALY for SA, while FRP outcomes were reported as catastrophic health expenditure (CHE) cases averted. Distributions of the outcomes were reported by income quintile and sex. Covering both diagnosis and treatment services for the bottom two quintiles resulted in the greatest INMB (USD22 per person) and the greatest CHE cases averted. There were greater FRP benefits for women compared to men. A CCT programme covering diabetes diagnosis and treatment services was found to be cost-effective, when provided to the poorest 40% of the SA population. ECEA provides a useful platform for including equity considerations to inform priority setting and implementation policies in SA.
南非糖尿病患病率不断上升，加上诊断和治疗需求远未得到满足，导致糖尿病相关并发症的发生率很高。收入状况是诊断和治疗服务利用情况的一个决定因素，交通成本和工资损失是获得医疗服务的主要障碍。一项旨在补偿此类成本的有条件现金转移支付（CCT）计划可能会提高服务利用率。我们应用了扩展成本效益分析（ECEA）方法，并使用马尔可夫模型比较了CCT计划的成本、健康效益和金融风险保护（FRP）属性。根据从南非特定数据得出的特定概率，模拟了一个人群，该人群在45年的时间跨度内每年经历各种健康状态的转变。将成本和残疾调整生命年（DALYs）应用于每个健康状态。模拟了三种CCT计划策略，并与“无计划”情景进行比较：（1）仅涵盖诊断服务；（2）仅涵盖治疗服务；（3）涵盖诊断和治疗服务。成本效益以增量净货币效益（INMB）报告，使用南非每DALY 3015美元的成本效益阈值，而FRP结果以避免的灾难性医疗支出（CHE）病例报告。结果分布按收入五分位数和性别报告。为最底层的两个五分位数人群提供诊断和治疗服务，带来了最大的INMB（每人22美元）和最多的CHE病例避免数。女性获得的FRP收益高于男性。当向南非最贫困的40%人口提供涵盖糖尿病诊断和治疗服务的CCT计划时，发现该计划具有成本效益。ECEA为纳入公平考虑因素以指导南非的优先事项设定和实施政策提供了一个有用的平台。
