Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics

A model-based economic evaluation informed by complexity science methods

Datos Bibliográficos

ID21880324
AutoresFiammetta Bozzani (0000-0002-9518-6885, London School of Hygiene & Tropical Medicine, autor de correspondencia), Nicky McCreesh (0000-0003-1409-8531, London School of Hygiene & Tropical Medicine), Karin Diaconu (0000-0002-5810-9725, Queen Margaret University), Indira Govender (0000-0003-0598-7388, London School of Hygiene & Tropical Medicine), Richard G White (0000-0003-4410-6635, London School of Hygiene & Tropical Medicine), Karina Kielmann (0000-0001-5519-1658, Queen Margaret University), Anne D Grant (0000-0002-2437-5195, London School of Hygiene & Tropical Medicine), Anna Vassall (0000-0002-2911-1375, London School of Hygiene & Tropical Medicine)
Año2023
Volumen8
Número2
Páginase010306
Fecha de publicación2023-02-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2022-010306
PMID36792227
OpenAlexW4320914723
IdiomaEN
Citas recibidas1
Referencias citadas30

Introduction Nosocomial Mycobacterium tuberculosis ( Mtb ) transmission substantially impacts health workers, patients and communities. Guidelines for tuberculosis infection prevention and control (TB IPC) exist but implementation in many settings remains suboptimal. Evidence is needed on cost-effective investments to prevent Mtb transmission that are feasible in routine clinic environments. Methods A set of TB IPC interventions was codesigned with local stakeholders using system dynamics modelling techniques that addressed both core activities and enabling actions to support implementation. An economic evaluation of these interventions was conducted at two clinics in KwaZulu-Natal, employing agent-based models of Mtb transmission within the clinics and in their catchment populations. Intervention costs included the costs of the enablers (eg, strengthened supervision, community sensitisation) identified by stakeholders to ensure uptake and adherence. Results All intervention scenarios modelled, inclusive of the relevant enablers, cost less than US$200 per disability-adjusted life-year (DALY) averted and were very cost-effective in comparison to South Africa’s opportunity cost-based threshold (US$3200 per DALY averted). Two interventions, building modifications to improve ventilation and maximising use of the existing Central Chronic Medicines Dispensing and Distribution system to reduce the number of clinic attendees, were found to be cost saving over the 10-year model time horizon. Incremental cost-effectiveness ratios were sensitive to assumptions on baseline clinic ventilation rates, the prevalence of infectious TB in clinic attendees and future HIV incidence but remained highly cost-effective under all uncertainty analysis scenarios. Conclusion TB IPC interventions in clinics, including the enabling actions to ensure their feasibility, afford very good value for money and should be prioritised for implementation within the South African health system

Business · Cost effectiveness · Cost-effectiveness analysis · Cost–benefit analysis · Economic evaluation · Environmental health · Health economics · Infection control · Intensive care medicine · Psychological intervention · Public health · Time horizon · Tuberculosis · Complex Systems and Decision Making · Computer Science · Health Systems, Economic Evaluations, Quality of Life · Medicine · Nursing · Tuberculosis Research and Epidemiology · Finance