National Project Implementation Plan - NVBDCP
National Project Implementation Plan - NVBDCP
National Project Implementation Plan - NVBDCP
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diagnosis and treatment, causing substantial emotional and economic hardship<br />
for affected families (Ahluwalia et al 2003).23<br />
With effective case management it is possible to eliminate kala azar, and case<br />
management is more cost-effective than vector control. Recent studies24 show<br />
kala azar treatment to be extremely cost-effective as it costs US$315 per death<br />
averted and US$9 per DALY gained.25<br />
To gain a perspective on cost-effectiveness of malaria and kala azar<br />
interventions we present cost-effectiveness of a few comparators. Improved<br />
case management and immunization (currently undergoing clinical trials) for<br />
dengue costs US$ 587 to US$ 1440 per DALY averted. Similarly, among<br />
interventions against diarrheal disease during the first year of life, oral<br />
dehydration therapy costs US$ 132 to US$ 2570 per DALY averted and cholera<br />
immunizations costs US$ 1658 to US$ 8274 per DALY averted. Malaria and kala<br />
azar interventions, in comparison, are highly cost effective.<br />
A small exercise on cost-effectiveness of introducing ACT using Indian data<br />
suggests that under the proposed policy, the unit cost of both diagnosis and<br />
treatment will be over ten-fold higher than that of current policy (Rs.7.5 vs. Rs.<br />
77.8). Even though the new protocol may appear to be expensive, the real<br />
benefits accrue in terms of reduced transmission and reduced mortality. The<br />
steep reduction in hospitalizations and mortality as well as the reduction in<br />
transmission (as seen in other parts of the world) will more than compensate<br />
for the initial increase in costs. With the estimated reduction in transmission,<br />
after five years of implementation, the cost of the new policy will only be<br />
around 68% more than the current policy (Rs. 1073 million vs. Rs. 1633 million<br />
in the 100 districts), but will avert around 66,000 estimated hospitalizations<br />
and about 13,200 deaths (see the analysis below).<br />
Cost benefit analysis of switching from the current to the new protocol for the<br />
diagnosis and treatment of malaria<br />
MOHFW/<strong>NVBDCP</strong> has implemented Artemisinin derivative Combination<br />
Therapy (ACT), in all the World Bank’s 50 project districts and districts under<br />
GFATM. ACTs have high efficacy but are also much more expensive - up to 10-<br />
20 fold. Still, the cost of adopting ACT needs to be assessed and compared with<br />
the cost of current protocol being followed in India. Studies have linked the<br />
23 Ahluwalia I B et al. (2003). Visceral leishmaniasis: consequences of a neglected disease in a<br />
Bangladeshi community. Am. J. Trop. Med. Hyg., 69(6), pp. 624-628.<br />
24 For example, Laxminarayan, R., et al, Intervention Cost-effectiveness: Overview of Main<br />
Messages, Chapter 2 in Disease Control Priorities in Developing Countries 2006, pages 35-86.<br />
25 One DALY (Disability-Adjusted Life Year) represents a lost year of healthy life due to poor health<br />
or disability and potential years of life lost due to premature death.<br />
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