Cost-effectiveness of a trap to capture the dengue adult vector

in the context of the Public Health System in Brazil

Authors: Fabiana Raynal Floriano; Luis Eugenio Portela; Sebastião Loureiro; Martha Teixeira; Gimena M. Santos; Vanessa C.G.S. Morato; Maria da Glória Teixeira; Patrícia Barber; Naomar de Almeida Filho

Introduction

Source: http://www.cdc.gov/ncidod/dvbid/dengue/map-distribution-2005.htm

Figure 1: Distribution of Dengue around the world, 2005.

Source: http://www2.datasus.gov.br/DATASUS/index.php

Figure 2: Dengue incidence between 2001 and 2011 in Salvador, Bahia and Brazil.

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 - Costs Health Care Cost All stages of the disease progression (MH, 2011) Direct medical costs: diagnostic tests; drugs;

service: professional fees and hospitalization

Materials and Method - Costs Health 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 - Costs Health 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 cases

Cost-Effectiveness Decision tree analytical model

Sensitivity Analysis Effectiveness: highest and lowest dengue

incidence, in the last five years, in Salvador

Results

Table 1: Total cost (USD) of dengue treatment, according to risk classification, 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 and Hospitalization 11.78 (5.07) 27.26 (5.04) 2,445.69 (41.04) 4,030.96 (43.79)

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)

Results

Table 2: Dengue cases, total cost and cost average case (USD), in the intervention and control areas, Salvador, Bahia, Brazil, 2011.

Itens Intervention Area Control Area Difference Between Areas

Incidence 12.73% 14.38% -1.65

Dengue Case 69,533 78,545 -9,012

Treatment Cost 32,773,670.58 37,021,632.60 - 4,247,962.02

Technology Cost 2,770,471.25 0.00 2,770,471.25

Total Cost 35,544,141.83 37,021,632.60 - 1,477,490.77

Cost Average Case 511.19 471.34 39.85

Areas Cost (C)

Effectiveness (E) C/E Cost Effectiveness

(Prevented Cases) ICER

Intervention 35,544,141.83 69,533 511.19 - 1,477,490.76 -9,012 163.94

Control 37,021,632.60 78,545 471.34

Sensitivity 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

ResultsTable 3: Cost-Effectiveness (C/E), Incremental Cost-Effectiveness Ratio (ICER) and Sensitivity Analysis of control and intervention areas, Salvador, Bahia, Brazil, 2011.

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

Conclusion

Bibliographical References1. BRASIL. Ministério da Saúde. Banco de Dados do Sistema Único de Saúde – DATASUS. http://www2.datasus.gov.br/DATASUS/index.php.2. BRASIL. Ministério da Saúde. Programa Nacional de Controle da Dengue. 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 de Vigilância 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.

Contacts:fabianaraynal@hotmail.com

Web site:http://www.inct-citecs.ufba.br

http://www.isc.ufba.br/index.phphttp://www.pbct.inweb.org.br/pbct/