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  5. A new approach to Health Benefits Package design: an application of the Thanzi La Onse model in Malawi
 
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A new approach to Health Benefits Package design: an application of the Thanzi La Onse model in Malawi
File(s)
journal.pcbi.1012462.pdf (3.38 MB)
Published version (uncorrected proof)
Author(s)
Molaro, Margherita
Mohan, Sakshi
She, Bingling
Chalkley, Martin
Colbourn, Tim
more
Type
Journal Article
Abstract
An efficient allocation of limited resources in low-income settings offers the opportunity to improve population-health outcomes given the available health system capacity. Efforts to achieve this are often framed through the lens of “health benefits packages” (HBPs), which seek to establish which services the public healthcare system should include in its provision. Analytic approaches widely used to weigh evidence in support of different interventions and inform the broader HBP deliberative process however have limitations. In this work, we propose the individual-based Thanzi La Onse (TLO) model as a uniquely-tailored tool to assist in the evaluation of Malawi-specific HBPs while addressing these limitations. By mechanistically modelling—and calibrating to extensive, country-specific data—the incidence of disease, health-seeking behaviour, and the capacity of the healthcare system to meet the demand for care under realistic constraints on human resources for health available, we were able to simulate the health gains achievable under a number of plausible HBP strategies for the country. We found that the HBP emerging from a linear constrained optimisation analysis (LCOA) achieved the largest health gain—∼8% reduction in disability adjusted life years (DALYs) between 2023 and 2042 compared to the benchmark scenario—by concentrating resources on high-impact treatments. This HBP however incurred a relative excess in DALYs in the first few years of its implementation. Other feasible approaches to prioritisation were assessed, including service prioritisation based on patient characteristics, rather than service type. Unlike the LCOA-based HBP, this approach achieved consistent health gains relative to the benchmark scenario on a year- to-year basis, and a 5% reduction in DALYs over the whole period, which suggests an approach based upon patient characteristics might prove beneficial in the future.
Editor(s)
Scarpino, Samuel V
Date Issued
2024-09-30
Date Acceptance
2024-09-05
Citation
PLoS Computational Biology, 2024, 20 (9)
URI
http://hdl.handle.net/10044/1/114982
URL
http://dx.doi.org/10.1371/journal.pcbi.1012462
DOI
https://www.dx.doi.org/10.1371/journal.pcbi.1012462
ISSN
1553-734X
Publisher
Public Library of Science (PLoS)
Journal / Book Title
PLoS Computational Biology
Volume
20
Issue
9
Copyright Statement
© 2024 Molaro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
License URL
https://creativecommons.org/licenses/by/4.0/
Identifier
http://dx.doi.org/10.1371/journal.pcbi.1012462
Publication Status
Published online
Article Number
e1012462
Date Publish Online
2024-09-30
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