Cost-effectiveness of treating multidrug-resistant tuberculosis in treatment initiative centers and treatment follow-up centers in Ethiopia
In Ethiopia, MDR-TB has become a significant public health threat; therefore, the Ministry of Health introduced two treatment approaches for MDR-TB cases: treatment initiative center (TIC) and treatment follow-up center (TFC). TIC is where patients usually are diagnosed and start the treatment. At T...
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| description | In Ethiopia, MDR-TB has become a significant public health threat; therefore, the Ministry of Health introduced two treatment approaches for MDR-TB cases: treatment initiative center (TIC) and treatment follow-up center (TFC). TIC is where patients usually are diagnosed and start the treatment. At TFC, we follow MDR-TB patients until they completed the treatment. However, there is no evidence about the cost-effectiveness of the approaches. Therefore, this study aimed to analyze the cost-effectiveness of MDR-TB treatment in TIC and TFC.
In this study, we employed a full economic evaluation from a providers' perspective. We followed a hypothetical cohort of individuals from the age of 15 for a lifetime using a Markov model with five mutually exclusive health states. We used both primary and secondary data sources for the study. Ingredient-based costing approach was used. The costs include healthcare provider costs (recurrent and capital cost) and patient-side costs (direct and indirect). We use a human capital approach to estimate the indirect cost. The cost estimates were reported in the 2017 United States Dollar (US$), and effectiveness was measured using disability-adjusted life-years (DALYs) averted. Both costs and health benefits were discounted using a 3% discount rate. Both average and incremental cost-effectiveness ratios (ICER) were reported calculated. One-way and probabilistic sensitivity analyses were reported to determine the robustness of the estimates.
The cost per HIV negative patient successfully treated for MDR-TB was $8,416 at TIC and $6,657 at TFC. The average cost-effectiveness ratio per DALY averted at TFC was $671 and $1,417 per DALY averted at TIC. The incremental cost-effectiveness ratio (ICER) of MDR-TB treatment at TIC was $1,641 per DALYs averted.
This study indicates that the treatment of MDR-TB at both TIC and TFC are cost-effective interventions compared with the willingness to pay threshold of three-times the GDP per capita in Ethiopia. |
| doi_str_mv | 10.1371/journal.pone.0235820 |
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In this study, we employed a full economic evaluation from a providers' perspective. We followed a hypothetical cohort of individuals from the age of 15 for a lifetime using a Markov model with five mutually exclusive health states. We used both primary and secondary data sources for the study. Ingredient-based costing approach was used. The costs include healthcare provider costs (recurrent and capital cost) and patient-side costs (direct and indirect). We use a human capital approach to estimate the indirect cost. The cost estimates were reported in the 2017 United States Dollar (US$), and effectiveness was measured using disability-adjusted life-years (DALYs) averted. Both costs and health benefits were discounted using a 3% discount rate. Both average and incremental cost-effectiveness ratios (ICER) were reported calculated. One-way and probabilistic sensitivity analyses were reported to determine the robustness of the estimates.
The cost per HIV negative patient successfully treated for MDR-TB was $8,416 at TIC and $6,657 at TFC. The average cost-effectiveness ratio per DALY averted at TFC was $671 and $1,417 per DALY averted at TIC. The incremental cost-effectiveness ratio (ICER) of MDR-TB treatment at TIC was $1,641 per DALYs averted.
This study indicates that the treatment of MDR-TB at both TIC and TFC are cost-effective interventions compared with the willingness to pay threshold of three-times the GDP per capita in Ethiopia.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0235820</identifier><identifier>PMID: 32716915</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Aged ; Antitubercular agents ; Antitubercular Agents - economics ; Antitubercular Agents - therapeutic use ; Biology and Life Sciences ; Cost benefit analysis ; Cost estimates ; Costs ; Drug Costs ; Drug therapy ; Ethiopia - epidemiology ; Evaluation ; Extensively drug-resistant tuberculosis ; Female ; Follow-Up Studies ; Health Care Costs ; Health facilities ; Health risks ; HIV ; Hospitals ; Human capital ; Human immunodeficiency virus ; Humans ; Laboratories ; Male ; Markov chains ; Medicine and Health Sciences ; Middle Aged ; Multidrug resistance ; Multidrug resistant organisms ; Patient outcomes ; Patients ; People and Places ; Public health ; Quality-Adjusted Life Years ; Sensitivity analysis ; Social Sciences ; Tuberculosis ; Tuberculosis, Multidrug-Resistant - drug therapy ; Tuberculosis, Multidrug-Resistant - economics ; Tuberculosis, Multidrug-Resistant - epidemiology ; Young Adult</subject><ispartof>PloS one, 2020-07, Vol.15 (7), p.e0235820-e0235820</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Alemayehu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Alemayehu et al 2020 Alemayehu et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-4e446955a0dea7ece7511320bbdcdefbbf247d4ff3cee5ad2e222c33c842032f3</citedby><cites>FETCH-LOGICAL-c692t-4e446955a0dea7ece7511320bbdcdefbbf247d4ff3cee5ad2e222c33c842032f3</cites><orcidid>0000-0003-4872-8036</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384609/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384609/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,2103,2929,23868,27926,27927,53793,53795</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32716915$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>McCreesh, Nicky</contributor><creatorcontrib>Alemayehu, Senait</creatorcontrib><creatorcontrib>Yigezu, Amanuel</creatorcontrib><creatorcontrib>Hailemariam, Damen</creatorcontrib><creatorcontrib>Hailu, Alemayehu</creatorcontrib><title>Cost-effectiveness of treating multidrug-resistant tuberculosis in treatment initiative centers and treatment follow-up centers in Ethiopia</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In Ethiopia, MDR-TB has become a significant public health threat; therefore, the Ministry of Health introduced two treatment approaches for MDR-TB cases: treatment initiative center (TIC) and treatment follow-up center (TFC). TIC is where patients usually are diagnosed and start the treatment. At TFC, we follow MDR-TB patients until they completed the treatment. However, there is no evidence about the cost-effectiveness of the approaches. Therefore, this study aimed to analyze the cost-effectiveness of MDR-TB treatment in TIC and TFC.
In this study, we employed a full economic evaluation from a providers' perspective. We followed a hypothetical cohort of individuals from the age of 15 for a lifetime using a Markov model with five mutually exclusive health states. We used both primary and secondary data sources for the study. Ingredient-based costing approach was used. The costs include healthcare provider costs (recurrent and capital cost) and patient-side costs (direct and indirect). We use a human capital approach to estimate the indirect cost. The cost estimates were reported in the 2017 United States Dollar (US$), and effectiveness was measured using disability-adjusted life-years (DALYs) averted. Both costs and health benefits were discounted using a 3% discount rate. Both average and incremental cost-effectiveness ratios (ICER) were reported calculated. One-way and probabilistic sensitivity analyses were reported to determine the robustness of the estimates.
The cost per HIV negative patient successfully treated for MDR-TB was $8,416 at TIC and $6,657 at TFC. The average cost-effectiveness ratio per DALY averted at TFC was $671 and $1,417 per DALY averted at TIC. The incremental cost-effectiveness ratio (ICER) of MDR-TB treatment at TIC was $1,641 per DALYs averted.
This study indicates that the treatment of MDR-TB at both TIC and TFC are cost-effective interventions compared with the willingness to pay threshold of three-times the GDP per capita in Ethiopia.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antitubercular agents</subject><subject>Antitubercular Agents - economics</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>Biology and Life Sciences</subject><subject>Cost benefit analysis</subject><subject>Cost estimates</subject><subject>Costs</subject><subject>Drug Costs</subject><subject>Drug therapy</subject><subject>Ethiopia - epidemiology</subject><subject>Evaluation</subject><subject>Extensively drug-resistant tuberculosis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health Care Costs</subject><subject>Health facilities</subject><subject>Health risks</subject><subject>HIV</subject><subject>Hospitals</subject><subject>Human capital</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Male</subject><subject>Markov chains</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Multidrug resistance</subject><subject>Multidrug resistant organisms</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>People and Places</subject><subject>Public health</subject><subject>Quality-Adjusted Life Years</subject><subject>Sensitivity analysis</subject><subject>Social Sciences</subject><subject>Tuberculosis</subject><subject>Tuberculosis, Multidrug-Resistant - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alemayehu, Senait</au><au>Yigezu, Amanuel</au><au>Hailemariam, Damen</au><au>Hailu, Alemayehu</au><au>McCreesh, Nicky</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effectiveness of treating multidrug-resistant tuberculosis in treatment initiative centers and treatment follow-up centers in Ethiopia</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-07-27</date><risdate>2020</risdate><volume>15</volume><issue>7</issue><spage>e0235820</spage><epage>e0235820</epage><pages>e0235820-e0235820</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In Ethiopia, MDR-TB has become a significant public health threat; therefore, the Ministry of Health introduced two treatment approaches for MDR-TB cases: treatment initiative center (TIC) and treatment follow-up center (TFC). TIC is where patients usually are diagnosed and start the treatment. At TFC, we follow MDR-TB patients until they completed the treatment. However, there is no evidence about the cost-effectiveness of the approaches. Therefore, this study aimed to analyze the cost-effectiveness of MDR-TB treatment in TIC and TFC.
In this study, we employed a full economic evaluation from a providers' perspective. We followed a hypothetical cohort of individuals from the age of 15 for a lifetime using a Markov model with five mutually exclusive health states. We used both primary and secondary data sources for the study. Ingredient-based costing approach was used. The costs include healthcare provider costs (recurrent and capital cost) and patient-side costs (direct and indirect). We use a human capital approach to estimate the indirect cost. The cost estimates were reported in the 2017 United States Dollar (US$), and effectiveness was measured using disability-adjusted life-years (DALYs) averted. Both costs and health benefits were discounted using a 3% discount rate. Both average and incremental cost-effectiveness ratios (ICER) were reported calculated. One-way and probabilistic sensitivity analyses were reported to determine the robustness of the estimates.
The cost per HIV negative patient successfully treated for MDR-TB was $8,416 at TIC and $6,657 at TFC. The average cost-effectiveness ratio per DALY averted at TFC was $671 and $1,417 per DALY averted at TIC. The incremental cost-effectiveness ratio (ICER) of MDR-TB treatment at TIC was $1,641 per DALYs averted.
This study indicates that the treatment of MDR-TB at both TIC and TFC are cost-effective interventions compared with the willingness to pay threshold of three-times the GDP per capita in Ethiopia.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32716915</pmid><doi>10.1371/journal.pone.0235820</doi><tpages>e0235820</tpages><orcidid>https://orcid.org/0000-0003-4872-8036</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2020-07, Vol.15 (7), p.e0235820-e0235820 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2427511278 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adolescent Adult Aged Antitubercular agents Antitubercular Agents - economics Antitubercular Agents - therapeutic use Biology and Life Sciences Cost benefit analysis Cost estimates Costs Drug Costs Drug therapy Ethiopia - epidemiology Evaluation Extensively drug-resistant tuberculosis Female Follow-Up Studies Health Care Costs Health facilities Health risks HIV Hospitals Human capital Human immunodeficiency virus Humans Laboratories Male Markov chains Medicine and Health Sciences Middle Aged Multidrug resistance Multidrug resistant organisms Patient outcomes Patients People and Places Public health Quality-Adjusted Life Years Sensitivity analysis Social Sciences Tuberculosis Tuberculosis, Multidrug-Resistant - drug therapy Tuberculosis, Multidrug-Resistant - economics Tuberculosis, Multidrug-Resistant - epidemiology Young Adult |
| title | Cost-effectiveness of treating multidrug-resistant tuberculosis in treatment initiative centers and treatment follow-up centers in Ethiopia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-18T11%3A40%3A33IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Cost-effectiveness%20of%20treating%20multidrug-resistant%20tuberculosis%20in%20treatment%20initiative%20centers%20and%20treatment%20follow-up%20centers%20in%20Ethiopia&rft.jtitle=PloS%20one&rft.au=Alemayehu,%20Senait&rft.date=2020-07-27&rft.volume=15&rft.issue=7&rft.spage=e0235820&rft.epage=e0235820&rft.pages=e0235820-e0235820&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0235820&rft_dat=%3Cgale_plos_%3EA630721865%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2427511278&rft_id=info:pmid/32716915&rft_galeid=A630721865&rft_doaj_id=oai_doaj_org_article_5825e019abd946218e46f9479898fd89&rfr_iscdi=true |