Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review.

This systematic review aimed to address the existing evidence gaps, and guide policy decisions on the settings within which to treat infants <12 months of age with growth faltering/failure, and infants and children aged <60 months with moderate wasting or severe wasting and/or bilateral pitting oedema. Twelve electronic databases were searched for studies published before 10 December 2021. The searches yielded 16,709 records from which 31 studies were eligible and included in the review. Three studies were judged as low quality, whilst 14 were moderate and the remaining 14 were high quality. We identified very few cost and cost-effectiveness analyses for most of the models of care with the certainty of evidence being judged at very low or low. However, there were 17 cost and 6 cost-effectiveness analyses for the initiation of treatment in outpatient settings for severe wasting and/or bilateral pitting oedema in infants and children <60 months of age. From this evidence, the costs appear lowest for initiating treatment in community settings, followed by initiating treatment in community and transferring to outpatient settings, initiating treatment in outpatients then transferring to community settings, initiating treatment in outpatient settings, and lastly initiating treatment in inpatient settings. In addition, the evidence suggested that initiation of treatment in outpatient settings is highly cost-effective when compared to doing nothing or no programme implementation scenarios, using country-specific WHO GDP per capita thresholds. The incremental cost-effectiveness ratios ranged from $20 to $145 per DALY averted from a provider perspective, and $68 to $161 per DALY averted from a societal perspective. However, the certainty of the evidence was judged as moderate because of comparisons to do nothing/ no programme scenarios which potentially limits the applicability of the evidence in real-world settings. There is therefore a need for evidence that compare the different available alternatives.

Effect of relative income price on smoking initiation among adolescents in Ghana: evidence from pseudo-longitudinal data.

OBJECTIVE: Many smokers initiate smoking during adolescence. Making tobacco products less affordable is one of the best ways to control tobacco use. Studies on the effect of relative income price (RIP (ie, affordability)) of cigarettes on smoking initiation are scarce in low-income and middle-income countries, especially in Sub-Saharan Africa where data are limited. The goal of this study is to examine the effect of cigarette RIP on adolescent smoking initiation in Ghana. SETTING: The study uses a pseudo-longitudinal data set constructed from the Global Youth Tobacco Surveys (GYTS (2000-2009 and 2017)) and RIP for the most sold cigarette brand in Ghana. PARTICIPANTS: The GYTS is a national survey on adolescents. PRIMARY AND SECONDARY OUTCOME: Effect of RIP on adolescent smoking initiation in Ghana. RESULTS: Using the GYTS 2000-2009 data, we find that the probability of smoking initiation falls significantly in response to a higher RIP, with an elasticity of -0.372 (95% CI -0.701 to -0.042) for the unmatched sample and -0.490 (95% CI -0.818 to -0.161) for the matched sample. The RIP elasticity for women ((-0.888) (95% CI -1.384 to -0.392) and (-0.928) (95% CI -1.434 to -0.422)) is statistically significant at 1% in both the unmatched and the matched samples, respectively, while the RIP elasticity for men is statistically insignificant in the 2000-2009 surveys. Analysis of the 2017 GYTS shows a similar outcome: a negative relationship between RIP and smoking initiation, and the results are statistically significant for both men and women, and for both matched and unmatched samples. CONCLUSION: The affordability (RIP) of cigarettes is negatively related to the probability of smoking initiation among adolescents in Ghana. Raising tobacco taxes in line with income growth would make cigarettes less affordable and dissuade adolescents from initiating smoking.

Estimating the price elasticity of demand for cigarettes in South Africa using the Deaton approach.

OBJECTIVE: To estimate the price elasticity of demand for South Africa and thereby contribute to growing the evidence base of the likely impact of excise taxes on cigarette demand in low-income and middle-income countries. METHODS: We employ the Deaton method, using wave 5 data from the South African National Income Dynamics Study, to estimate the cigarette price elasticity for South Africa. We used a sample of 6820 households. RESULTS: Of the 6 820 households in the sample for which we had sufficient data, 1341 (19.7%) spent money on tobacco. The price elasticity of demand for cigarettes is estimated at -0.86 (95% CI -1.37 to -0.35), implying that the demand for cigarettes in South Africa declines by 8.6% for every 10% increase in price. CONCLUSION: The negative price elasticity estimate for South Africa indicates that increases in the excise tax are particularly effective in controlling cigarette consumption. However, given the presence of a significant illicit tobacco market in the country, it is important that authorities augment tax measures with strategies that curb the illicit trade in cigarettes.