M Siapka1, A Vassall1, L Cunnama2, C Pineda3, D Cerecero3, S Sweeney1, S Bautista-Arredondo3, L Bollinger4, D Cameron5, C Levin6, G B Gomez1. 1. Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK. 2. Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. 3. National Institute of Public Health (INSP), Mexico City, Mexico. 4. Avenir Health, Glastonbury, CT. 5. University of California, Berkeley, CA. 6. University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND: Despite a scarcity of tuberculosis (TB) cost data, a substantial body of evidence has been accumulating for drug-susceptible TB (DS-TB) treatment. In this study, we review unit costs for DS-TB treatment from a provider´s perspective. We also examine factors driving cost variations and extrapolate unit costs across low- and middle-income countries (LMICs). METHODS: We searched published and grey literature for any empirically collected TB cost estimates. We selected a subgroup of estimates looking at DS-TB treatment. We extracted information on activities and inputs included. We standardised costs into an average per person-month, fitted a multi-level regression model and cross-validated country-level predictions. We then extrapolated estimates for facility-based, directly observed DS-TB treatment across countries. RESULTS: We included 95 cost estimates from 28 studies across 17 countries. Costs predictions were sensitive to characteristics such as delivery mode, whether hospitalisation was included, and inputs accounted for, as well as gross domestic product per capita. Extrapolation results are presented with uncertainty intervals (UIs) for LMICs. Predicted median costs per 6 months of treatment were US$315.30 (95% CI US$222.60-US$417.20) for low-income, US$527.10 (95% CI US$395.70-US$743.70) for lower middle-income and US$896.40 (95% CI US$654.00-US$1214.40) for upper middle-income countries. CONCLUSIONS: Our study provides country-level DS-TB treatment cost estimates suitable for priority setting. These estimates, while not standing as a substitute for local high-quality primary data, can inform global, regional and national exercises.
BACKGROUND: Despite a scarcity of tuberculosis (TB) cost data, a substantial body of evidence has been accumulating for drug-susceptible TB (DS-TB) treatment. In this study, we review unit costs for DS-TB treatment from a provider´s perspective. We also examine factors driving cost variations and extrapolate unit costs across low- and middle-income countries (LMICs). METHODS: We searched published and grey literature for any empirically collected TB cost estimates. We selected a subgroup of estimates looking at DS-TB treatment. We extracted information on activities and inputs included. We standardised costs into an average per person-month, fitted a multi-level regression model and cross-validated country-level predictions. We then extrapolated estimates for facility-based, directly observed DS-TB treatment across countries. RESULTS: We included 95 cost estimates from 28 studies across 17 countries. Costs predictions were sensitive to characteristics such as delivery mode, whether hospitalisation was included, and inputs accounted for, as well as gross domestic product per capita. Extrapolation results are presented with uncertainty intervals (UIs) for LMICs. Predicted median costs per 6 months of treatment were US$315.30 (95% CI US$222.60-US$417.20) for low-income, US$527.10 (95% CI US$395.70-US$743.70) for lower middle-income and US$896.40 (95% CI US$654.00-US$1214.40) for upper middle-income countries. CONCLUSIONS: Our study provides country-level DS-TB treatment cost estimates suitable for priority setting. These estimates, while not standing as a substitute for local high-quality primary data, can inform global, regional and national exercises.
Authors: I Chikovani; N Shengelia; N Marjanishvili; T Gabunia; I Khonelidze; L Cunnama; I Garcia Baena; N Kitson; S Sweeney; A Vassall; Y V Laurence Journal: Int J Tuberc Lung Dis Date: 2021-12-01 Impact factor: 2.373
Authors: Jinyi Zhu; Goodluck Lyatuu; Christopher R Sudfeld; Anna Kiravu; David Sando; Lameck Machumi; John Minde; Fikiri Chisonjela; Ted Cohen; Nicolas A Menzies Journal: Lancet Glob Health Date: 2022-11 Impact factor: 38.927