http://repub.eur.nl/res/aut/19966/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/34929/ 2012-08-01T00:00:00Z Objective Breast cancer control in Ghana is characterised by low awareness, late-stage treatment and poor survival. In settings with severely constrained health resources, there is a need to spend money wisely. To achieve this and to guide policy makers in their selection of interventions, this study systematically compares costs and effects of breast cancer control interventions in Ghana. Methods We used a mathematical model to estimate costs and health effects of breast cancer interventions in Ghana from the healthcare perspective. Analyses were based on the WHO-CHOICE method, with health effects expressed in disability-adjusted life years (DALYs), costs in 2009 US dollars (US$) and cost-effectiveness ratios (CERs) in US$ per DALY averted. Analyses were based on local demographic, epidemiological and economic data, to the extent these data were available. Results Biennial screening by clinical breast examination (CBE) of women aged 40-69years, in combination with treatment of all stages, seems the most cost-effective intervention (costing $1299 per DALY averted). The intervention is also economically attractive according to international standards on cost-effectiveness. Mass media awareness raising (MAR) is the second best option (costing $1364 per DALY averted). Mammography screening of women of aged 40-69years (costing $12908 per DALY averted) cannot be considered cost-effective. Conclusions Both CBE screening and MAR seem economically attractive interventions. Given the uncertainty about the effectiveness of these interventions, only their phased introduction, carefully monitored and evaluated, is warranted. Moreover, their implementation is only meaningful if the capacity of basic cancer diagnostic, referral and treatment and possibly palliative services is simultaneously improved. http://repub.eur.nl/res/pub/34719/ 2012-03-01T00:00:00Z Objective: To develop two practical methods for measuring the affordability of medicines in developing countries. Methods The proposed methods - catastrophic and impoverishment methods - rely on easily accessible aggregated expenditure data and take into account a country's income distribution and absolute level of income. The catastrophic method quantifies the proportion of the population whose resources would be catastrophically reduced by spending on a given medicine; the impoverishment method estimates the proportion of the population that would be pushed below the poverty line by procuring a given medicine. These methods are illustrated by calculating the afford ability of glibenclamide, an antidiabetic drug, in India and Indonesia. The results were validated by comparing them with the results obtained by using household micro data for India and Indonesia. Findings when accurate aggregate data are available, the proposed methods offer a practical way to obtain informative and accurate estimates of affordability. Their results are very similar to those obtained with household micro data analysis and are easily compared across countries. Conclusion The catastrophic and impoverishment methods, based on macro data, can provide a suitable estimate of medicine affordability when the household level micro data needed to carry out more sophisticated studies are not available. Their usefulness depends on the availability of accurate aggregated data. http://repub.eur.nl/res/pub/30779/ 2012-01-06T00:00:00Z http://repub.eur.nl/res/pub/19443/ 2009-12-01T00:00:00Z Objectives. Given that HIV/AIDS in sub-Saharan Africa is largely spread through heterosexual contact, there is marked variation in levels of gender equity across sub-Saharan African countries, and levels of gender equity are likely to influence both exposure to sexual practices that increase the likelihood of exposure to HIV and the efficacy of prevention programs, we hypothesize that levels of gender equity account for the levels of and changes in the prevalence of HIV/AIDS across sub-Saharan African countries. Methods. We explore this hypothesis by first discussing the role of gender and several other contextual variables in the spread of HIV/AIDS. The resulting model is tested with regression analyses of both the level and change of HIV/AIDS in sub-Saharan African. Result. We find strong support for our hypothesis. Conclusion. This suggests that further policy attention be given to gender equity in combating HIV/AIDS. http://repub.eur.nl/res/pub/16581/ 2009-03-27T00:00:00Z