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Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence

Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence
Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence
Background: The HIV epidemic has caused a dramatic increase in tuberculosis (TB) in East and southern Africa. Several strategies have the potential to reduce the burden of TB in high HIV prevalence settings, and cost and cost-effectiveness analyses can help to prioritize them when budget constraints exist. However, published cost and cost-effectiveness studies are limited.
Methods: Our objective was to compare the cost, affordability and cost-effectiveness of seven strategies for reducing the burden of TB in countries with high HIV prevalence. A compartmental difference equation model of TB and HIV and recent cost data were used to assess the costs (year 2003 US$ prices) and effects (TB cases averted, deaths averted, DALYs gained) of these strategies in Kenya during the period 2004-2023.
Results: The three lowest cost and most cost-effective strategies were improving TB cure rates, improving TB case detection rates, and improving both together. The incremental cost of combined improvements to case detection and cure was below US$15 million per year (7.5% of year 2000 government health expenditure); the mean cost per DALY gained of these three strategies ranged from US$18 to US$34. Antiretroviral therapy (ART) had the highest incremental costs, which by 2007 could be as large as total government health expenditures in year 2000. ART could also gain more DALYs than the other strategies, at a cost per DALY gained of around US$260 to US$530. Both the costs and effects of treatment for latent tuberculosis infection (TLTI) for HIV+ individuals were low; the cost per DALY gained ranged from about US$85 to US$370. Averting one HIV infection for less than US$250 would be as cost-effective as improving TB case detection and cure rates to WHO target levels.
Conclusions: To reduce the burden of TB in high HIV prevalence settings, the immediate goal should be to increase TB case detection rates and, to the extent possible, improve TB cure rates, preferably in combination. Realising the full potential of ART will require substantial new funding and strengthening of health system capacity so that increased funding can be used effectively.
1471-2458
Currie, Christine S.M.
dcfd0972-1b42-4fac-8a67-0258cfdeb55a
Floyd, Katherine
42fd01f5-2035-4591-a4e5-436d61f2175e
Williams, Brian G.
35236c71-cd95-42bd-9e26-455d1ac36b98
Dye, Christopher
73ab1d1e-80ee-496e-9765-6842739fd843
Currie, Christine S.M.
dcfd0972-1b42-4fac-8a67-0258cfdeb55a
Floyd, Katherine
42fd01f5-2035-4591-a4e5-436d61f2175e
Williams, Brian G.
35236c71-cd95-42bd-9e26-455d1ac36b98
Dye, Christopher
73ab1d1e-80ee-496e-9765-6842739fd843

Currie, Christine S.M., Floyd, Katherine, Williams, Brian G. and Dye, Christopher (2005) Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence. BMC Public Health, 5 (130). (doi:10.1186/1471-2458-5-130).

Record type: Article

Abstract

Background: The HIV epidemic has caused a dramatic increase in tuberculosis (TB) in East and southern Africa. Several strategies have the potential to reduce the burden of TB in high HIV prevalence settings, and cost and cost-effectiveness analyses can help to prioritize them when budget constraints exist. However, published cost and cost-effectiveness studies are limited.
Methods: Our objective was to compare the cost, affordability and cost-effectiveness of seven strategies for reducing the burden of TB in countries with high HIV prevalence. A compartmental difference equation model of TB and HIV and recent cost data were used to assess the costs (year 2003 US$ prices) and effects (TB cases averted, deaths averted, DALYs gained) of these strategies in Kenya during the period 2004-2023.
Results: The three lowest cost and most cost-effective strategies were improving TB cure rates, improving TB case detection rates, and improving both together. The incremental cost of combined improvements to case detection and cure was below US$15 million per year (7.5% of year 2000 government health expenditure); the mean cost per DALY gained of these three strategies ranged from US$18 to US$34. Antiretroviral therapy (ART) had the highest incremental costs, which by 2007 could be as large as total government health expenditures in year 2000. ART could also gain more DALYs than the other strategies, at a cost per DALY gained of around US$260 to US$530. Both the costs and effects of treatment for latent tuberculosis infection (TLTI) for HIV+ individuals were low; the cost per DALY gained ranged from about US$85 to US$370. Averting one HIV infection for less than US$250 would be as cost-effective as improving TB case detection and cure rates to WHO target levels.
Conclusions: To reduce the burden of TB in high HIV prevalence settings, the immediate goal should be to increase TB case detection rates and, to the extent possible, improve TB cure rates, preferably in combination. Realising the full potential of ART will require substantial new funding and strengthening of health system capacity so that increased funding can be used effectively.

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Published date: 2005
Organisations: Operational Research

Identifiers

Local EPrints ID: 29635
URI: https://eprints.soton.ac.uk/id/eprint/29635
ISSN: 1471-2458
PURE UUID: 4cf02233-0a74-48d0-a9b0-12b178e37259
ORCID for Christine S.M. Currie: ORCID iD orcid.org/0000-0002-7016-3652

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Date deposited: 11 May 2006
Last modified: 08 Jan 2019 01:35

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