Assessing Global Evidence on Cost-Effectiveness to Inform Development of Pakistan's Essential Package of Health Services.

BACKGROUND: Countries designing a health benefit package (HBP) to support progress towards universal health coverage (UHC) require robust cost-effectiveness evidence. This paper reports on Pakistan's approach to assessing the applicability of global cost-effectiveness evidence to country context as part of a HBP design process. METHODS: A seven-step process was developed and implemented with Disease Control Priority 3 (DCP3) project partners to assess the applicability of global incremental cost-effectiveness ratios (ICERs) to Pakistan. First, the scope of the interventions to be assessed was defined and an independent, interdisciplinary team was formed. Second, the team familiarized itself with intervention descriptions. Third, the team identified studies from the Tufts Medical School Global Health Cost-Effectiveness Analysis (GH-CEA) registry. Fourth, the team applied specific knock-out criteria to match identified studies to local intervention descriptions. Matches were then cross-checked across reviewers and further selection was made where there were multiple ICER matches. Sixth, a quality scoring system was applied to ICER values. Finally, a database was created containing all the ICER results with a justification for each decision, which was made available to decision-makers during HBP deliberation. RESULTS: We found that less than 50% of the interventions in DCP3 could be supported with evidence of cost-effectiveness applicable to the country context. Out of 78 ICERs identified as applicable to Pakistan from the Tufts GH-CEA registry, only 20 ICERs were exact matches of the DCP3 Pakistan intervention descriptions and 58 were partial matches. CONCLUSION: This paper presents the first attempt globally to use the main public GH-CEA database to estimate cost-effectiveness in the context of HBPs at a country level. This approach is a useful learning for all countries trying to develop essential packages informed by the global database on ICERs, and it will support the design of future evidence and further development of methods.

Microwave-assisted synthesis of carbon dots as reductant and stabilizer for silver nanoparticles with enhanced-peroxidase like activity for colorimetric determination of hydrogen peroxide and glucose.

A carbon silver nano-assembly was prepared from silver nanoparticles and carbon dots (AgNP@CD). It was used to quantify hydrogen peroxide and glucose by UV-visible spectroscopy. Banana peels were used to prepare the CDs by a microwave-assisted method. The CDs can be prepared within 5 min at 700 W. They act as (a) substrate, (b) stabilizer, and (c) reductant to convert silver ions to AgNPs. The nano-assembly was characterized by UV-visible spectroscopy, Fourier-transform infrared spectroscopy, atomic force microscopy, and transmission electron microscopy. The CDs have a particle size of 1.4 nm. Photoexcitation of the CDs with a UV lamp of 365 nm results in blue fluorescence. The absorption spectra of the CDs show a peak at 205 nm along the wide shoulder absorption band. On incorporation of the Ag nanoparticles into the CDs matrix, the color of the CDs turns into yellow and an additional absorbance peak at 408 nm appears. FTIR spectroscopy shows that different functional groups are present on the CDs. They are responsible for the stabilization of the AgNPs. On exposure to H2O2, the color of the nano-assembly disappears gradually. Hence, the assembly can be used as a colorimetric indicator probe for H2O2 with a linear response in the 0.1-100 µM concentration range. It can also be applied to the determination of glucose by using glucose oxidase which causes the formation of H2O2 from glucose. The linear response ranges from 1- 600 µM. The detection limits for H2O2 and glucose are 9 nM and 10 nM, respectively. In our perception, this is the lowest detection limit reported so far. The AgNP@CD nano-assembly does not respond to saccharides, maltose, fructose, and lactose. It can be used to quantify glucose in diluted blood plasma. Graphical abstractSchematic representation of microwave-assisted synthesis of AgNP@CDs with enhanced-peroxidase like activity for colorimetric determination of hydrogen peroxide and glucose.