Work Package 2: Economic Sub-studies


The economic analyses are led by Prof. Louis Niessen and Dr. Tinevimbo Shiri from LSTM, and are a vital element in the evaluation of the trial’s success. The analyses will estimate the cost consequences and the cost-effectiveness of the intervention arm compared to the current standard of care treatment in each of the five country settings.

We anticipate that the intervention arm will:

  • Show a zero net societal cost change, or generate societal cost savings, reducing hospitalisation costs over the trial time horizon.
  • Be cost-effective in terms societal and service cost of life years saved within the diversity of Sub-Saharan settings, compared to historical cohorts under the current national treatment regimens.

We also anticipate that the economic evidence will support wide-scale implementations following trial completion.


  • Initial comparison of societal and health service costs of the standard of care regimens in each country in which patients will be recruited.
  • Publication of an economic protocol manuscript, which can be found here
  • Capture of patient-level resource and unit costs through the electronic Case Report Forms
  • Empirical cost-consequence analysis using this individual patient data
  • Development and refinement of data collection tools and costing studies in all five countries
  • Cost-effectiveness modelling at LSTM

Capacity Building

To enable early assimilation of the principles, an intensive Health Economics Course was held in Blantyre, Malawi, from 20 – 24 November 2017. Led by Prof. Niessen and assisted by two of his PhD students, Lucky Ngwira and Dr. Jane Bates, the course introduced the fundaments of Health Economics, both in a broad sense and with specific application to AMBITION. Attendees were drawn from all AMBITION recruiting sites and were joined by a number of  local delegates in Blantyre.

Dr. Tinevimbo Shiri, our Health Economist from LSTM, took the opportunity to visit a number of AMBITION sites during January 2019. He visited the team at BHP in Gaborone from 21-22 January, then the team at UNC Project Malawi in Lilongwe from 23-25 January 2019. These visits provided a valuable opportunity to discuss the methods and implementation face-to-face with the teams on the ground.

In Gaborone, Tinevimbo had the opportunity to tour the hospital facilities, and to meet with the entire study team to gather feedback on the Health Economics sub-study (Work Package 2). On his final day, he delivered some focused teaching on the sub-study and provided an introduction to economic evaluations within clinical trials. He also worked with Dr. David Lawrence to review the Health Economics data provided to date in the AMBITION EDC.

In Lilongwe, Tinevimbo had a fruitful meeting with Dr. Cecelia Kanyama, Dr. Timothy Kachitosi and Chimwemwe Chawinga on the next steps for the development of a costing tool in Lilongwe. After working with David to review the Health Economics CRFs for patients recruited in Lilongwe, Tinevimbo delivered a lecture on the Health Economics sub-study, including an introduction to economic evaluations within clinical trials which was well attended by a wider audience at UNC Project. This was concluded by a review and feedback session with the clinical team on the sub-study thus far.

A huge thank you to the study teams in both Gaborone and Lilongwe and in particular to Dr. Mosepele Mosepele, Dr. Cecelia Kanyama and Prof. Mina Hosseinipour who made Tinevimbo’s trip successful, and for warmly welcoming him. He thoroughly enjoyed collaborating with his fellow AMBITION colleagues.

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