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Modeling the Cost-Effectiveness of Interventions to Prevent Plague in Madagascar
Plague (Yersinia pestis) remains endemic in certain parts of the world. We assessed the cost-effectiveness of plague control interventions recommended by the World Health Organization with particular consideration to intervention coverage and timing. We developed a dynamic model of the spread of pla...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293333/ https://www.ncbi.nlm.nih.gov/pubmed/34208006 http://dx.doi.org/10.3390/tropicalmed6020101 |
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author | Malloy, Giovanni S. P. Brandeau, Margaret L. Goldhaber-Fiebert, Jeremy D. |
author_facet | Malloy, Giovanni S. P. Brandeau, Margaret L. Goldhaber-Fiebert, Jeremy D. |
author_sort | Malloy, Giovanni S. P. |
collection | PubMed |
description | Plague (Yersinia pestis) remains endemic in certain parts of the world. We assessed the cost-effectiveness of plague control interventions recommended by the World Health Organization with particular consideration to intervention coverage and timing. We developed a dynamic model of the spread of plague between interacting populations of humans, rats, and fleas and performed a cost-effectiveness analysis calibrated to a 2017 Madagascar outbreak. We assessed three interventions alone and in combination: expanded access to antibiotic treatment with doxycycline, mass distribution of doxycycline prophylaxis, and mass distribution of malathion. We varied intervention timing and coverage levels. We calculated costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios from a healthcare perspective. The preferred intervention, using a cost-effectiveness threshold of $1350/QALY (GDP per capita in Madagascar), was expanded access to antibiotic treatment with doxycycline with 100% coverage starting immediately after the first reported case, gaining 543 QALYs at an incremental cost of $1023/QALY gained. Sensitivity analyses support expanded access to antibiotic treatment and leave open the possibility that mass distribution of doxycycline prophylaxis or mass distribution of malathion could be cost-effective. Our analysis highlights the potential for rapid expansion of access to doxycycline upon recognition of plague outbreaks to cost-effectively prevent future large-scale plague outbreaks and highlights the importance of intervention timing. |
format | Online Article Text |
id | pubmed-8293333 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-82933332021-07-22 Modeling the Cost-Effectiveness of Interventions to Prevent Plague in Madagascar Malloy, Giovanni S. P. Brandeau, Margaret L. Goldhaber-Fiebert, Jeremy D. Trop Med Infect Dis Article Plague (Yersinia pestis) remains endemic in certain parts of the world. We assessed the cost-effectiveness of plague control interventions recommended by the World Health Organization with particular consideration to intervention coverage and timing. We developed a dynamic model of the spread of plague between interacting populations of humans, rats, and fleas and performed a cost-effectiveness analysis calibrated to a 2017 Madagascar outbreak. We assessed three interventions alone and in combination: expanded access to antibiotic treatment with doxycycline, mass distribution of doxycycline prophylaxis, and mass distribution of malathion. We varied intervention timing and coverage levels. We calculated costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios from a healthcare perspective. The preferred intervention, using a cost-effectiveness threshold of $1350/QALY (GDP per capita in Madagascar), was expanded access to antibiotic treatment with doxycycline with 100% coverage starting immediately after the first reported case, gaining 543 QALYs at an incremental cost of $1023/QALY gained. Sensitivity analyses support expanded access to antibiotic treatment and leave open the possibility that mass distribution of doxycycline prophylaxis or mass distribution of malathion could be cost-effective. Our analysis highlights the potential for rapid expansion of access to doxycycline upon recognition of plague outbreaks to cost-effectively prevent future large-scale plague outbreaks and highlights the importance of intervention timing. MDPI 2021-06-11 /pmc/articles/PMC8293333/ /pubmed/34208006 http://dx.doi.org/10.3390/tropicalmed6020101 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Malloy, Giovanni S. P. Brandeau, Margaret L. Goldhaber-Fiebert, Jeremy D. Modeling the Cost-Effectiveness of Interventions to Prevent Plague in Madagascar |
title | Modeling the Cost-Effectiveness of Interventions to Prevent Plague in Madagascar |
title_full | Modeling the Cost-Effectiveness of Interventions to Prevent Plague in Madagascar |
title_fullStr | Modeling the Cost-Effectiveness of Interventions to Prevent Plague in Madagascar |
title_full_unstemmed | Modeling the Cost-Effectiveness of Interventions to Prevent Plague in Madagascar |
title_short | Modeling the Cost-Effectiveness of Interventions to Prevent Plague in Madagascar |
title_sort | modeling the cost-effectiveness of interventions to prevent plague in madagascar |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293333/ https://www.ncbi.nlm.nih.gov/pubmed/34208006 http://dx.doi.org/10.3390/tropicalmed6020101 |
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