Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis
Summary: Background: Dengue has become a major public health problem in Sri Lanka with a considerable economic burden. As a response, in June, 2014, the Ministry of Health initiated a proactive vector control programme in partnership with military and police forces, known as the Civil-Military Coop...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-05-01
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| Series: | The Lancet Planetary Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2542519619300579 |
| _version_ | 1818953546075209728 |
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| author | Prasad Liyanage, MBBS Joacim Rocklöv, ProfPhD Hasitha Tissera, MD (Comm Med) Paba Palihawadana, MD (Comm Med) Annelies Wilder-Smith, ProfPhD Yesim Tozan, PhD |
| author_facet | Prasad Liyanage, MBBS Joacim Rocklöv, ProfPhD Hasitha Tissera, MD (Comm Med) Paba Palihawadana, MD (Comm Med) Annelies Wilder-Smith, ProfPhD Yesim Tozan, PhD |
| author_sort | Prasad Liyanage, MBBS |
| collection | DOAJ |
| description | Summary: Background: Dengue has become a major public health problem in Sri Lanka with a considerable economic burden. As a response, in June, 2014, the Ministry of Health initiated a proactive vector control programme in partnership with military and police forces, known as the Civil-Military Cooperation (CIMIC) programme, that was targeted at high-risk Medical Officer of Health (MOH) divisions in the country. Evaluating the effectiveness and cost-effectiveness of population-level interventions is essential to guide public health planning and resource allocation decisions, particularly in resource-limited health-care settings. Methods: Using an interrupted time series design with a non-linear extension, we evaluated the impact of vector control interventions from June 22, 2014, to Dec 29, 2016, in Panadura, a high-risk MOH division in Western Province, Sri Lanka. We used dengue notification and larval survey data to estimate the reduction in Breteau index and dengue incidence before and after the intervention using two separate models, adjusting for time-varying confounding variables (ie, rainfall, temperature, and the Oceanic Niño Index). We also assessed the cost and cost-effectiveness of the CIMIC programme from the perspective of the National Dengue Control Unit under the scenarios of different levels of hospitalisation of dengue cases (low [25%], medium [50%], and high [75%]) in terms of cost per disability-adjusted life-year averted (DALY). Findings: Vector control interventions had a significant impact on combined Breteau index (relative risk reduction 0·43, 95% CI 0·26 to 0·70) and on dengue incidence (0·43, 0·28 to 0·67), the latter becoming prominent 2 months after the intervention onset. The mean number of averted dengue cases was estimated at 2192 (95% CI 1741 to 2643), and the total cost of the CIMIC programme at 2016 US$271 615. Personnel costs accounted for about 89% of the total cost. In the base-case scenario of moderate level of hospitalisation, the CIMIC programme was cost-saving with a probability of 70% under both the lowest ($453) and highest ($1686) cost-effectiveness thresholds, resulting in a net saving of $20 247 (95% CI −57 266 to 97 790) and averting 176 DALYs (133 to 226), leading to a cost of −$98 (−497 to 395) per DALY averted. This was also the case for the scenario with high hospitalisation levels (cost per DALY averted −$512, 95% CI −872 to −115) but with a higher probability of 99%. In the scenario with low hospitalisation levels (cost per DALY averted $690, 143 to 1379), although the CIMIC programme was cost-ineffective at the lowest threshold with a probability of 77%, it was cost-effective at the highest threshold with a probability of 99%. Interpretation: This study suggests that communities affected by dengue can benefit from investments in vector control if interventions are implemented rigorously and coordinated well across sectors. By doing so, it is possible to reduce the disease and economic burden of dengue in endemic settings. Funding: None. |
| first_indexed | 2024-12-20T10:07:59Z |
| format | Article |
| id | doaj.art-2680def7c8304909a8635661ee5669cc |
| institution | Directory Open Access Journal |
| issn | 2542-5196 |
| language | English |
| last_indexed | 2024-12-20T10:07:59Z |
| publishDate | 2019-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Planetary Health |
| spelling | doaj.art-2680def7c8304909a8635661ee5669cc2022-12-21T19:44:12ZengElsevierThe Lancet Planetary Health2542-51962019-05-0135e211e218Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysisPrasad Liyanage, MBBS0Joacim Rocklöv, ProfPhD1Hasitha Tissera, MD (Comm Med)2Paba Palihawadana, MD (Comm Med)3Annelies Wilder-Smith, ProfPhD4Yesim Tozan, PhD5Ministry of Health, Colombo, Sri Lanka; Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, SE–901 87, Umeå, SwedenDepartment of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, SE–901 87, Umeå, SwedenMinistry of Health, Colombo, Sri LankaMinistry of Health, Colombo, Sri LankaDepartment of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, SE–901 87, Umeå, Sweden; Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UKGlobal Health and Environmental Public Health Sciences Program, College of Global Public Health, New York University, New York, NY, USA; Correspondence to: Assistant Prof Yesim Tozan, College of Global Public Health, New York University, New York, NY 10012, USASummary: Background: Dengue has become a major public health problem in Sri Lanka with a considerable economic burden. As a response, in June, 2014, the Ministry of Health initiated a proactive vector control programme in partnership with military and police forces, known as the Civil-Military Cooperation (CIMIC) programme, that was targeted at high-risk Medical Officer of Health (MOH) divisions in the country. Evaluating the effectiveness and cost-effectiveness of population-level interventions is essential to guide public health planning and resource allocation decisions, particularly in resource-limited health-care settings. Methods: Using an interrupted time series design with a non-linear extension, we evaluated the impact of vector control interventions from June 22, 2014, to Dec 29, 2016, in Panadura, a high-risk MOH division in Western Province, Sri Lanka. We used dengue notification and larval survey data to estimate the reduction in Breteau index and dengue incidence before and after the intervention using two separate models, adjusting for time-varying confounding variables (ie, rainfall, temperature, and the Oceanic Niño Index). We also assessed the cost and cost-effectiveness of the CIMIC programme from the perspective of the National Dengue Control Unit under the scenarios of different levels of hospitalisation of dengue cases (low [25%], medium [50%], and high [75%]) in terms of cost per disability-adjusted life-year averted (DALY). Findings: Vector control interventions had a significant impact on combined Breteau index (relative risk reduction 0·43, 95% CI 0·26 to 0·70) and on dengue incidence (0·43, 0·28 to 0·67), the latter becoming prominent 2 months after the intervention onset. The mean number of averted dengue cases was estimated at 2192 (95% CI 1741 to 2643), and the total cost of the CIMIC programme at 2016 US$271 615. Personnel costs accounted for about 89% of the total cost. In the base-case scenario of moderate level of hospitalisation, the CIMIC programme was cost-saving with a probability of 70% under both the lowest ($453) and highest ($1686) cost-effectiveness thresholds, resulting in a net saving of $20 247 (95% CI −57 266 to 97 790) and averting 176 DALYs (133 to 226), leading to a cost of −$98 (−497 to 395) per DALY averted. This was also the case for the scenario with high hospitalisation levels (cost per DALY averted −$512, 95% CI −872 to −115) but with a higher probability of 99%. In the scenario with low hospitalisation levels (cost per DALY averted $690, 143 to 1379), although the CIMIC programme was cost-ineffective at the lowest threshold with a probability of 77%, it was cost-effective at the highest threshold with a probability of 99%. Interpretation: This study suggests that communities affected by dengue can benefit from investments in vector control if interventions are implemented rigorously and coordinated well across sectors. By doing so, it is possible to reduce the disease and economic burden of dengue in endemic settings. Funding: None.http://www.sciencedirect.com/science/article/pii/S2542519619300579 |
| spellingShingle | Prasad Liyanage, MBBS Joacim Rocklöv, ProfPhD Hasitha Tissera, MD (Comm Med) Paba Palihawadana, MD (Comm Med) Annelies Wilder-Smith, ProfPhD Yesim Tozan, PhD Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis The Lancet Planetary Health |
| title | Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis |
| title_full | Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis |
| title_fullStr | Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis |
| title_full_unstemmed | Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis |
| title_short | Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis |
| title_sort | evaluation of intensified dengue control measures with interrupted time series analysis in the panadura medical officer of health division in sri lanka a case study and cost effectiveness analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2542519619300579 |
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