Is combination therapy for malaria based on user-fees worthwhile and equitable to consumers?: Assessment of costs and willingness to pay in Southeast Nigeria
Objectives: To examine the equity implications of the costs of an episode of malaria, the benefit/cost ratios of using two artemisinin-based combination therapy (CT) from the consumers’ view and inequities in willingness to pay (WTP) for CT. Methods: A cross-sectional survey was conducted in Southea...
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| creator | Onwujekwe, Obinna Uzochukwu, Benjamin Shu, Elvis Ibeh, Christian Okonkwo, Paul |
| description | Objectives: To examine the equity implications of the costs of an episode of malaria, the benefit/cost ratios of using two artemisinin-based combination therapy (CT) from the consumers’ view and inequities in willingness to pay (WTP) for CT.
Methods: A cross-sectional survey was conducted in Southeast Nigeria, where there is a moderate to high level of malaria resistance to chloroquine and sulfadoxine–pyrimethamine formulations. WTP was elicited from respondents using the bidding game (BG) and the structured haggling technique (SH). A socio-economic status (SES) index was used to examine the level of inequity in the key variables. In the benefit/cost ratios, the average cost of CT in Nigeria and price of Coartem
R were, respectively, used as the cost inputs while the mean WTP was the measure of benefit. Multiple regression analyses were used to determine the validity of the WTP estimates.
Results: More than 90% of the respondents were willing to pay for CT. The mean WTP in the BG was 301.1 Naira while it was 438.0 Naira in the SH. People in the highest SES quartile (Q4) were more willing to pay for CT than the lowest SES quartile (Q1). In the regression models, the SES quartiles were significantly related to levels of WTP. The benefit/cost ratios were higher in the SH group, and the ratio was only more than 1 using Coartem
R in only the SH group. The Q1 groups had the least benefit cost-ratios but the trend of SES differentials in benefit/cost ratios were not statistically significant in the BG group but was in the SH group.
Conclusion: CT based on user-fees may not be worthwhile and equitable because there are economic and equity constraints to its wide-scale use. Benefit/cost ratios depend on the type of questions that were used to elicit WTP. Governments and donors should be willing to commit funds to make CT affordable to the poor consumers for the intervention to be used to significantly reduce the burden of malaria. |
| doi_str_mv | 10.1016/j.actatropica.2004.03.005 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_32634208</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0001706X0400066X</els_id><sourcerecordid>32634208</sourcerecordid><originalsourceid>FETCH-LOGICAL-e328t-a34249b5445e655fee3d1215033c5a2a00d1ec86c1efa7c1d7a20dd58f4833</originalsourceid><addsrcrecordid>eNpNkd1u1DAQhSMEokvhFZC5gLsE_8RJlhtUrfipVIEEXHBnTZxJ16vE3nqcrvZheFe8dJF6NRqdb87Yc4rijeCV4KJ5v6vAJkgx7J2FSnJeV1xVnOsnxUp0rSobqeunxYpzLsqWN78vihdEu9zJVsvnxYXQUtWNXq-KP9fEbJh75yG54FnaYoT9kY0hshkmiA5YD4QDy-JCGMsRkdghxLQ9bN2EDPzA8G5xCfrcpZDtPC0zRvr4gV0RIdGMPrEwZoUS_Rs4uGly_tZn8TSyhyNznv0MS94PlNg3d4t59cvi2QgT4atzvSx-fP70a_O1vPn-5XpzdVOikl0qQdWyXve6rjU2WucXqkFIoblSVoMEzgeBtmuswBFaK4YWJB8G3Y11p9Rl8e7BdB_D3YKUzOzI4jSBx7CQUbLJ_rzL4OszuPQzDmYf3QzxaP5fMwNvzwCQhWmM4K2jR9y6bjvRZm7zwGH-073DaMg69BYHF9EmMwRnBDenrM3OPMranLI2XJmctfoLRleieQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>32634208</pqid></control><display><type>article</type><title>Is combination therapy for malaria based on user-fees worthwhile and equitable to consumers?: Assessment of costs and willingness to pay in Southeast Nigeria</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Onwujekwe, Obinna ; Uzochukwu, Benjamin ; Shu, Elvis ; Ibeh, Christian ; Okonkwo, Paul</creator><creatorcontrib>Onwujekwe, Obinna ; Uzochukwu, Benjamin ; Shu, Elvis ; Ibeh, Christian ; Okonkwo, Paul</creatorcontrib><description>Objectives: To examine the equity implications of the costs of an episode of malaria, the benefit/cost ratios of using two artemisinin-based combination therapy (CT) from the consumers’ view and inequities in willingness to pay (WTP) for CT.
Methods: A cross-sectional survey was conducted in Southeast Nigeria, where there is a moderate to high level of malaria resistance to chloroquine and sulfadoxine–pyrimethamine formulations. WTP was elicited from respondents using the bidding game (BG) and the structured haggling technique (SH). A socio-economic status (SES) index was used to examine the level of inequity in the key variables. In the benefit/cost ratios, the average cost of CT in Nigeria and price of Coartem
R were, respectively, used as the cost inputs while the mean WTP was the measure of benefit. Multiple regression analyses were used to determine the validity of the WTP estimates.
Results: More than 90% of the respondents were willing to pay for CT. The mean WTP in the BG was 301.1 Naira while it was 438.0 Naira in the SH. People in the highest SES quartile (Q4) were more willing to pay for CT than the lowest SES quartile (Q1). In the regression models, the SES quartiles were significantly related to levels of WTP. The benefit/cost ratios were higher in the SH group, and the ratio was only more than 1 using Coartem
R in only the SH group. The Q1 groups had the least benefit cost-ratios but the trend of SES differentials in benefit/cost ratios were not statistically significant in the BG group but was in the SH group.
Conclusion: CT based on user-fees may not be worthwhile and equitable because there are economic and equity constraints to its wide-scale use. Benefit/cost ratios depend on the type of questions that were used to elicit WTP. Governments and donors should be willing to commit funds to make CT affordable to the poor consumers for the intervention to be used to significantly reduce the burden of malaria.</description><identifier>ISSN: 0001-706X</identifier><identifier>EISSN: 1873-6254</identifier><identifier>DOI: 10.1016/j.actatropica.2004.03.005</identifier><identifier>PMID: 15234659</identifier><identifier>CODEN: ACTRAQ</identifier><language>eng</language><publisher>Amsterdam: Elsevier B.V</publisher><subject>Antimalarials - economics ; Antimalarials - therapeutic use ; Artemisinins - economics ; Artemisinins - therapeutic use ; Benefit–cost ; Biological and medical sciences ; Combination therapy ; Cost-Benefit Analysis ; Costs ; Cross-Sectional Studies ; Drug Therapy, Combination ; Female ; Financing, Personal ; Human protozoal diseases ; Humans ; Income ; Inequality ; Infectious diseases ; Malaria ; Malaria, Falciparum - drug therapy ; Malaria, Falciparum - economics ; Male ; Medical sciences ; Middle Aged ; Nigeria ; Parasitic diseases ; Protozoal diseases ; Regression Analysis ; Sesquiterpenes - economics ; Sesquiterpenes - therapeutic use ; Social Class ; Surveys and Questionnaires ; Willingness to pay</subject><ispartof>Acta tropica, 2004-07, Vol.91 (2), p.101-115</ispartof><rights>2004</rights><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0001706X0400066X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15947817$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15234659$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Onwujekwe, Obinna</creatorcontrib><creatorcontrib>Uzochukwu, Benjamin</creatorcontrib><creatorcontrib>Shu, Elvis</creatorcontrib><creatorcontrib>Ibeh, Christian</creatorcontrib><creatorcontrib>Okonkwo, Paul</creatorcontrib><title>Is combination therapy for malaria based on user-fees worthwhile and equitable to consumers?: Assessment of costs and willingness to pay in Southeast Nigeria</title><title>Acta tropica</title><addtitle>Acta Trop</addtitle><description>Objectives: To examine the equity implications of the costs of an episode of malaria, the benefit/cost ratios of using two artemisinin-based combination therapy (CT) from the consumers’ view and inequities in willingness to pay (WTP) for CT.
Methods: A cross-sectional survey was conducted in Southeast Nigeria, where there is a moderate to high level of malaria resistance to chloroquine and sulfadoxine–pyrimethamine formulations. WTP was elicited from respondents using the bidding game (BG) and the structured haggling technique (SH). A socio-economic status (SES) index was used to examine the level of inequity in the key variables. In the benefit/cost ratios, the average cost of CT in Nigeria and price of Coartem
R were, respectively, used as the cost inputs while the mean WTP was the measure of benefit. Multiple regression analyses were used to determine the validity of the WTP estimates.
Results: More than 90% of the respondents were willing to pay for CT. The mean WTP in the BG was 301.1 Naira while it was 438.0 Naira in the SH. People in the highest SES quartile (Q4) were more willing to pay for CT than the lowest SES quartile (Q1). In the regression models, the SES quartiles were significantly related to levels of WTP. The benefit/cost ratios were higher in the SH group, and the ratio was only more than 1 using Coartem
R in only the SH group. The Q1 groups had the least benefit cost-ratios but the trend of SES differentials in benefit/cost ratios were not statistically significant in the BG group but was in the SH group.
Conclusion: CT based on user-fees may not be worthwhile and equitable because there are economic and equity constraints to its wide-scale use. Benefit/cost ratios depend on the type of questions that were used to elicit WTP. Governments and donors should be willing to commit funds to make CT affordable to the poor consumers for the intervention to be used to significantly reduce the burden of malaria.</description><subject>Antimalarials - economics</subject><subject>Antimalarials - therapeutic use</subject><subject>Artemisinins - economics</subject><subject>Artemisinins - therapeutic use</subject><subject>Benefit–cost</subject><subject>Biological and medical sciences</subject><subject>Combination therapy</subject><subject>Cost-Benefit Analysis</subject><subject>Costs</subject><subject>Cross-Sectional Studies</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Financing, Personal</subject><subject>Human protozoal diseases</subject><subject>Humans</subject><subject>Income</subject><subject>Inequality</subject><subject>Infectious diseases</subject><subject>Malaria</subject><subject>Malaria, Falciparum - drug therapy</subject><subject>Malaria, Falciparum - economics</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nigeria</subject><subject>Parasitic diseases</subject><subject>Protozoal diseases</subject><subject>Regression Analysis</subject><subject>Sesquiterpenes - economics</subject><subject>Sesquiterpenes - therapeutic use</subject><subject>Social Class</subject><subject>Surveys and Questionnaires</subject><subject>Willingness to pay</subject><issn>0001-706X</issn><issn>1873-6254</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkd1u1DAQhSMEokvhFZC5gLsE_8RJlhtUrfipVIEEXHBnTZxJ16vE3nqcrvZheFe8dJF6NRqdb87Yc4rijeCV4KJ5v6vAJkgx7J2FSnJeV1xVnOsnxUp0rSobqeunxYpzLsqWN78vihdEu9zJVsvnxYXQUtWNXq-KP9fEbJh75yG54FnaYoT9kY0hshkmiA5YD4QDy-JCGMsRkdghxLQ9bN2EDPzA8G5xCfrcpZDtPC0zRvr4gV0RIdGMPrEwZoUS_Rs4uGly_tZn8TSyhyNznv0MS94PlNg3d4t59cvi2QgT4atzvSx-fP70a_O1vPn-5XpzdVOikl0qQdWyXve6rjU2WucXqkFIoblSVoMEzgeBtmuswBFaK4YWJB8G3Y11p9Rl8e7BdB_D3YKUzOzI4jSBx7CQUbLJ_rzL4OszuPQzDmYf3QzxaP5fMwNvzwCQhWmM4K2jR9y6bjvRZm7zwGH-073DaMg69BYHF9EmMwRnBDenrM3OPMranLI2XJmctfoLRleieQ</recordid><startdate>20040701</startdate><enddate>20040701</enddate><creator>Onwujekwe, Obinna</creator><creator>Uzochukwu, Benjamin</creator><creator>Shu, Elvis</creator><creator>Ibeh, Christian</creator><creator>Okonkwo, Paul</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7U5</scope><scope>8FD</scope><scope>L7M</scope></search><sort><creationdate>20040701</creationdate><title>Is combination therapy for malaria based on user-fees worthwhile and equitable to consumers?: Assessment of costs and willingness to pay in Southeast Nigeria</title><author>Onwujekwe, Obinna ; Uzochukwu, Benjamin ; Shu, Elvis ; Ibeh, Christian ; Okonkwo, Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-e328t-a34249b5445e655fee3d1215033c5a2a00d1ec86c1efa7c1d7a20dd58f4833</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Antimalarials - economics</topic><topic>Antimalarials - therapeutic use</topic><topic>Artemisinins - economics</topic><topic>Artemisinins - therapeutic use</topic><topic>Benefit–cost</topic><topic>Biological and medical sciences</topic><topic>Combination therapy</topic><topic>Cost-Benefit Analysis</topic><topic>Costs</topic><topic>Cross-Sectional Studies</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Financing, Personal</topic><topic>Human protozoal diseases</topic><topic>Humans</topic><topic>Income</topic><topic>Inequality</topic><topic>Infectious diseases</topic><topic>Malaria</topic><topic>Malaria, Falciparum - drug therapy</topic><topic>Malaria, Falciparum - economics</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nigeria</topic><topic>Parasitic diseases</topic><topic>Protozoal diseases</topic><topic>Regression Analysis</topic><topic>Sesquiterpenes - economics</topic><topic>Sesquiterpenes - therapeutic use</topic><topic>Social Class</topic><topic>Surveys and Questionnaires</topic><topic>Willingness to pay</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Onwujekwe, Obinna</creatorcontrib><creatorcontrib>Uzochukwu, Benjamin</creatorcontrib><creatorcontrib>Shu, Elvis</creatorcontrib><creatorcontrib>Ibeh, Christian</creatorcontrib><creatorcontrib>Okonkwo, Paul</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Solid State and Superconductivity Abstracts</collection><collection>Technology Research Database</collection><collection>Advanced Technologies Database with Aerospace</collection><jtitle>Acta tropica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Onwujekwe, Obinna</au><au>Uzochukwu, Benjamin</au><au>Shu, Elvis</au><au>Ibeh, Christian</au><au>Okonkwo, Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is combination therapy for malaria based on user-fees worthwhile and equitable to consumers?: Assessment of costs and willingness to pay in Southeast Nigeria</atitle><jtitle>Acta tropica</jtitle><addtitle>Acta Trop</addtitle><date>2004-07-01</date><risdate>2004</risdate><volume>91</volume><issue>2</issue><spage>101</spage><epage>115</epage><pages>101-115</pages><issn>0001-706X</issn><eissn>1873-6254</eissn><coden>ACTRAQ</coden><abstract>Objectives: To examine the equity implications of the costs of an episode of malaria, the benefit/cost ratios of using two artemisinin-based combination therapy (CT) from the consumers’ view and inequities in willingness to pay (WTP) for CT.
Methods: A cross-sectional survey was conducted in Southeast Nigeria, where there is a moderate to high level of malaria resistance to chloroquine and sulfadoxine–pyrimethamine formulations. WTP was elicited from respondents using the bidding game (BG) and the structured haggling technique (SH). A socio-economic status (SES) index was used to examine the level of inequity in the key variables. In the benefit/cost ratios, the average cost of CT in Nigeria and price of Coartem
R were, respectively, used as the cost inputs while the mean WTP was the measure of benefit. Multiple regression analyses were used to determine the validity of the WTP estimates.
Results: More than 90% of the respondents were willing to pay for CT. The mean WTP in the BG was 301.1 Naira while it was 438.0 Naira in the SH. People in the highest SES quartile (Q4) were more willing to pay for CT than the lowest SES quartile (Q1). In the regression models, the SES quartiles were significantly related to levels of WTP. The benefit/cost ratios were higher in the SH group, and the ratio was only more than 1 using Coartem
R in only the SH group. The Q1 groups had the least benefit cost-ratios but the trend of SES differentials in benefit/cost ratios were not statistically significant in the BG group but was in the SH group.
Conclusion: CT based on user-fees may not be worthwhile and equitable because there are economic and equity constraints to its wide-scale use. Benefit/cost ratios depend on the type of questions that were used to elicit WTP. Governments and donors should be willing to commit funds to make CT affordable to the poor consumers for the intervention to be used to significantly reduce the burden of malaria.</abstract><cop>Amsterdam</cop><pub>Elsevier B.V</pub><pmid>15234659</pmid><doi>10.1016/j.actatropica.2004.03.005</doi><tpages>15</tpages></addata></record> |
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| subjects | Antimalarials - economics Antimalarials - therapeutic use Artemisinins - economics Artemisinins - therapeutic use Benefit–cost Biological and medical sciences Combination therapy Cost-Benefit Analysis Costs Cross-Sectional Studies Drug Therapy, Combination Female Financing, Personal Human protozoal diseases Humans Income Inequality Infectious diseases Malaria Malaria, Falciparum - drug therapy Malaria, Falciparum - economics Male Medical sciences Middle Aged Nigeria Parasitic diseases Protozoal diseases Regression Analysis Sesquiterpenes - economics Sesquiterpenes - therapeutic use Social Class Surveys and Questionnaires Willingness to pay |
| title | Is combination therapy for malaria based on user-fees worthwhile and equitable to consumers?: Assessment of costs and willingness to pay in Southeast Nigeria |
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