Sensitivity analysis allows for uncertainty within the economic evaluation. It shows how responsive the result is to changes in key economic parameters but also gives an indication of the robustness of the estimate to changes in unknown variables. Sensitivity analysis was undertaken to investigate the effect on the results of varying the discount rate (reduced to 1% and increased to 10%), the prices of the drugs (reduced by 10% and 20% to reflect the use of cheaper drugs in the future) and effectiveness of treatment in reducing the proportion of anaemia cases (reduced by 33% and 50% to reflect differences in the impact of treatment on anaemia in different transmission settings). One-way scenario sensitivity analysis was carried
out to assess the impact of key variables on estimates of the cost per anaemia case averted. Results Total financial and economic costs The total financial cost of the intervention in the six districts was estimated at US$161 312. The financial costs per district ranged from US$18 015 in Masindi district to US$33 809 in Hoimadistrict. The economic cost of the intervention was calculated byvaluing staff time and annuitizing capital costs to provide an equivalent annual cost. The economic costs of the intervention in each district are summarized by the major cost centres in Table 1. The total economic cost was estimated at US$218 303: ranging from US$25 624 in Masindi district to US$44 958 in Hoima district. In each district, the largest individual cost item was the purchase of drugs, ranging from 23.6% of total costs in Masindi district in 2003 to 52.1% in Moyo district in 2005. Community sensitization activities and IEC materials were the next largest
items (Table 1). Costs per children treated The overall financial cost per child treated in the six districts was US$0.39. The total economic cost per child treated in the six districts was US$0.54, which includes the imputed value of labour as well as annuitized capital costs. Considerable variation in the economic costs per child treated existed between districts and between years, ranging from US$0.41 to US$0.91 (Table 2). The economic delivery cost per child treated (which excludes drug cost) also varied considerably: US$0.19– 0.69. The cost per child treated is highly sensitive to the total
WinCE的电子点菜系统设计论文+源码+答辩PPT+参考文献number of children treated (Figure 2). Increasing the number of children treated can significantly decrease the cost per child treated (Figure 2a; Spearman’s rho: –0.93, P<0.001), suggestive of economies of scale. Similar economies of scale were observed in the delivery cost per child treated (Figure 2b; Spearman’s rho: –0.93, P<0.001). In order to investigate possible causes of observed variation in costs, the relationship between delivery cost per child treated and the percentage of overall costs due to different
cost centres was investigated. Cost per child treated was significantly associated with the percentage of overall costs due to sensitization and awareness (Spearman’s rho: 0.769, P¼0.0002). The majority of the costs involved here are per diem (allowances) rates paid to district officials, which ranged from US$4.95–15.44, although the correlation between allowance本文来自优.文~论^文·网原文请找腾讯3249.114
rates and cost per child treated was non-significant (Spearman’s rho: 0.19, P¼0.444). Differences in demographic and geographic factors, including distance of each district from Kampala, geographical area and population density of the district, and differences in epidemiological factors, such as
baseline intensity of infection and reduction in infection following treatment, were not significantly associated with costs per child treated. Cost-effectiveness
Among the 1455 children monitored for the 3-year period in
the six districts, the percentage of children anaemic, defined as Hb<110 g/L, fell from 35.2% in 2003 to 18.5% in 2005, following three rounds of treatment. This translates to a 52.5% reduction in the proportion of anaemia cases within the study population. Table 3 reports the proportion of anaemia
cases averted over the 3 year period by district. Overall, 0.4 million children were treated at an estimated cost of US$3.19 per case of anaemia averted. Cost-effectiveness ranged from US$1.70 in Moyo district to US$9.51 in Masindi district. Costeffectiveness decreased with increasing cost per child treated (Figure 3a; Spearman’s rho: 0.940.19, P¼0.005) and increased
with increasing difference in the proportion of anaemia averted as a result of the intervention (Figure 3b; Spearman’s rho: 1.0, P<0.0001). This suggests that neither costs nor effectiveness are constant and therefore cost-effectiveness varies between districts. Figure 3c indicates a negative association between cost-effectiveness and the number of children receiving
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