A new approach to Health Benefits Package design: an application of the Thanzi La Onse model in Malawi.

Autor: Molaro M; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, United Kingdom., Mohan S; Centre for Health Economics, University of York, York, United Kingdom., She B; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, United Kingdom., Chalkley M; Centre for Health Economics, University of York, York, United Kingdom., Colbourn T; Institute for Global Health, University College London, London, United Kingdom., Collins JH; Institute for Global Health, University College London, London, United Kingdom., Connolly E; London School of Hygiene and Tropical Medicine, London, United Kingdom., Graham MM; Centre for Advanced Research Computing, University College London, London, United Kingdom., Janoušková E; Institute for Global Health, University College London, London, United Kingdom., Li Lin I; Institute for Global Health, University College London, London, United Kingdom., Manthalu G; Department of Planning and Policy Development, Ministry of Health and Population, Lilongwe, Malawi., Mnjowe E; Kamuzu University of Health Sciences, Blantyre, Malawi., Nkhoma D; Kamuzu University of Health Sciences, Blantyre, Malawi., Twea PD; Department of Planning and Policy Development, Ministry of Health and Population, Lilongwe, Malawi., Phillips AN; Institute for Global Health, University College London, London, United Kingdom., Revill P; Centre for Health Economics, University of York, York, United Kingdom., Tamuri AU; Centre for Advanced Research Computing, University College London, London, United Kingdom., Mfutso-Bengo J; Kamuzu University of Health Sciences, Blantyre, Malawi., Mangal TD; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, United Kingdom.; Centre for Health Economics, University of York, York, United Kingdom., Hallett TB; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, United Kingdom.
Jazyk: angličtina
Zdroj: PLoS computational biology [PLoS Comput Biol] 2024 Sep 30; Vol. 20 (9), pp. e1012462. Date of Electronic Publication: 2024 Sep 30 (Print Publication: 2024).
DOI: 10.1371/journal.pcbi.1012462
Abstrakt: An efficient allocation of limited resources in low-income settings offers the opportunity to improve population-health outcomes given the available health system capacity. Efforts to achieve this are often framed through the lens of "health benefits packages" (HBPs), which seek to establish which services the public healthcare system should include in its provision. Analytic approaches widely used to weigh evidence in support of different interventions and inform the broader HBP deliberative process however have limitations. In this work, we propose the individual-based Thanzi La Onse (TLO) model as a uniquely-tailored tool to assist in the evaluation of Malawi-specific HBPs while addressing these limitations. By mechanistically modelling-and calibrating to extensive, country-specific data-the incidence of disease, health-seeking behaviour, and the capacity of the healthcare system to meet the demand for care under realistic constraints on human resources for health available, we were able to simulate the health gains achievable under a number of plausible HBP strategies for the country. We found that the HBP emerging from a linear constrained optimisation analysis (LCOA) achieved the largest health gain-∼8% reduction in disability adjusted life years (DALYs) between 2023 and 2042 compared to the benchmark scenario-by concentrating resources on high-impact treatments. This HBP however incurred a relative excess in DALYs in the first few years of its implementation. Other feasible approaches to prioritisation were assessed, including service prioritisation based on patient characteristics, rather than service type. Unlike the LCOA-based HBP, this approach achieved consistent health gains relative to the benchmark scenario on a year- to-year basis, and a 5% reduction in DALYs over the whole period, which suggests an approach based upon patient characteristics might prove beneficial in the future.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Molaro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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