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Kjell Arne Johansson Department of global and public health University of Bergen

Public finance of pneumococcal vaccine and pneumonia treatment in Ethiopia: - an extended cost-effectiveness analysis. Kjell Arne Johansson Department of global and public health University of Bergen Kjell.johansson@isf.uib.no Stephane Verguet Department of Global Health

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Kjell Arne Johansson Department of global and public health University of Bergen

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  1. Public finance of pneumococcal vaccine and pneumonia treatment in Ethiopia: - an extended cost-effectiveness analysis Kjell Arne Johansson Department of global and public health University of Bergen Kjell.johansson@isf.uib.no StephaneVerguet Department of Global Health University of Washington

  2. Plan • Burdenofpneomococcaldisease and pneumonia in Ethiopia • Health benefitsacrossincomegroups • Costsofpublicfinance • Income equivalentequityweights • Private expendituresaverted • Financial protection

  3. Objective • To evaluate the expected financial protection and health gains of two publicly financed child health programs in Ethiopia, pneumonia treatment and pneumococcal vaccination • Averages will be spread across income groups

  4. BACKGROUND Diseaseburden and DEMAND

  5. Diseaseburden and incomedistribution in Ethiopia

  6. Utilizationofhealth services

  7. Total costsofpublicfinanceofbothinterventions (close to 40% coverage)

  8. per 1,000,000 US$: PCV (0.2 US$): 3010 PCV (3.5 US$): 540 Antibiotics:560 Deaths averted

  9. Income equivalenthealthgains- distributive weightsapplied Ref: FleurbaeyM et al. Health Econ. 2012

  10. Fair evaluationof PCV/antibiotics- incomeequivalentweightsapplied Equivalent lives saved per 1,000,000 US$: PCV (0.2 US$): 3010  3060 (2%) Antibiotics:560  660 (18%)

  11. Financial protection

  12. Household expendituresaverted per 1,000,000 US$: PCV: 180,000 US$ Antibiotics:160,000 US$

  13. Utilitycurve for financialprotection U(y) = (y^(1-r) / (1-r) Ref. Finkelstein A., McKnight R. Journal of Public Economics. 2008; McClellan M, Skinner J, Journal of Public Economics. 2006;

  14. Expectedvalueofincome E(y) = (1 - I0(y))y + I0(y) (y - Ctreatment) Expectedvalueofutility Eu(y) = (1 - I0(y))u(y) + I0(y) u(y - Ctreatment) Insurance value / certaintyequivalent V(y) = E(y) – u-1[Eu(y)]

  15. Financial risk protection

  16. Health gains & financialprotection- per $1M spent

  17. Expecteddistributionofhealthgains & financialprotection (per $1M spent)

  18. Summary • Health distribution PCV saves most lives. Equivalent health gains improves the expected utilities the most for pneumonia treatment by giving more weight to health benefits to the poor • Financial protection Pneumonia treatment improves financial protection the most, especially for the poor • Normative problem Save the most lives (PCV) vs. improving financial protection the most (pneumonia treatment)

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