Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and Romania
High rates of drug-resistant tuberculosis (DR-TB) continue to threaten public health, especially in Eastern Europe. Costs for treating DR-TB are substantially higher than treating drug-susceptible TB, and higher yet if DR-TB services are delivered in hospital. The WHO recommends that multidrug-resis...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLOS Global Public Health |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10284374/?tool=EBI |
| _version_ | 1827828408746246144 |
|---|---|
| author | Sherrie L. Kelly Gerard Joseph Abou Jaoude Tom Palmer Jolene Skordis Hassan Haghparast-Bidgoli Lara Goscé Sarah J. Jarvis David J. Kedziora Romesh Abeysuriya Clemens Benedikt Nicole Fraser-Hurt Zara Shubber Nejma Cheikh Stela Bivol Anna Roberts David P. Wilson Rowan Martin-Hughes |
| author_facet | Sherrie L. Kelly Gerard Joseph Abou Jaoude Tom Palmer Jolene Skordis Hassan Haghparast-Bidgoli Lara Goscé Sarah J. Jarvis David J. Kedziora Romesh Abeysuriya Clemens Benedikt Nicole Fraser-Hurt Zara Shubber Nejma Cheikh Stela Bivol Anna Roberts David P. Wilson Rowan Martin-Hughes |
| author_sort | Sherrie L. Kelly |
| collection | DOAJ |
| description | High rates of drug-resistant tuberculosis (DR-TB) continue to threaten public health, especially in Eastern Europe. Costs for treating DR-TB are substantially higher than treating drug-susceptible TB, and higher yet if DR-TB services are delivered in hospital. The WHO recommends that multidrug-resistant (MDR) TB be treated using mainly ambulatory care, shown to have non-inferior health outcomes, however, there has been a delay to transition away from hospital-focused MDR-TB care in certain Eastern European countries. Allocative efficiency analyses were conducted for three countries in Eastern Europe, Belarus, the Republic of Moldova, and Romania, to minimise a combination of TB incidence, prevalence, and mortality by 2035. A primary focus of these studies was to determine the health benefits and financial savings that could be realised if DR-TB service delivery shifted from hospital-focused to ambulatory care. Here we provide a comprehensive assessment of findings from these studies to demonstrate the collective benefit of transitioning from hospital-focused to ambulatory TB care, and to address common regional considerations. We highlight that transitioning from hospital-focused to ambulatory TB care could reduce treatment costs by 20% in Romania, 24% in Moldova, and by as much as 40% in Belarus or almost 35 million US dollars across these three countries by 2035 without affecting quality of care. Improved TB outcomes could be achieved, however, without additional spending by reinvesting these savings in higher-impact TB diagnosis and more efficacious DR-TB treatment regimens. We found commonalities in the large portion of TB cases treated in hospital across these three regional countries, and similar obstacles to transitioning to ambulatory care. National governments in the Eastern European region should examine barriers delaying adoption of ambulatory DR-TB care and consider lost opportunities caused by delays in switching to more efficient treatment modes. |
| first_indexed | 2024-03-12T03:50:42Z |
| format | Article |
| id | doaj.art-95d3d1d7e1b041808d028a9484b3e9ba |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T03:50:42Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-95d3d1d7e1b041808d028a9484b3e9ba2023-09-03T12:23:33ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752023-01-0136Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and RomaniaSherrie L. KellyGerard Joseph Abou JaoudeTom PalmerJolene SkordisHassan Haghparast-BidgoliLara GoscéSarah J. JarvisDavid J. KedzioraRomesh AbeysuriyaClemens BenediktNicole Fraser-HurtZara ShubberNejma CheikhStela BivolAnna RobertsDavid P. WilsonRowan Martin-HughesHigh rates of drug-resistant tuberculosis (DR-TB) continue to threaten public health, especially in Eastern Europe. Costs for treating DR-TB are substantially higher than treating drug-susceptible TB, and higher yet if DR-TB services are delivered in hospital. The WHO recommends that multidrug-resistant (MDR) TB be treated using mainly ambulatory care, shown to have non-inferior health outcomes, however, there has been a delay to transition away from hospital-focused MDR-TB care in certain Eastern European countries. Allocative efficiency analyses were conducted for three countries in Eastern Europe, Belarus, the Republic of Moldova, and Romania, to minimise a combination of TB incidence, prevalence, and mortality by 2035. A primary focus of these studies was to determine the health benefits and financial savings that could be realised if DR-TB service delivery shifted from hospital-focused to ambulatory care. Here we provide a comprehensive assessment of findings from these studies to demonstrate the collective benefit of transitioning from hospital-focused to ambulatory TB care, and to address common regional considerations. We highlight that transitioning from hospital-focused to ambulatory TB care could reduce treatment costs by 20% in Romania, 24% in Moldova, and by as much as 40% in Belarus or almost 35 million US dollars across these three countries by 2035 without affecting quality of care. Improved TB outcomes could be achieved, however, without additional spending by reinvesting these savings in higher-impact TB diagnosis and more efficacious DR-TB treatment regimens. We found commonalities in the large portion of TB cases treated in hospital across these three regional countries, and similar obstacles to transitioning to ambulatory care. National governments in the Eastern European region should examine barriers delaying adoption of ambulatory DR-TB care and consider lost opportunities caused by delays in switching to more efficient treatment modes.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10284374/?tool=EBI |
| spellingShingle | Sherrie L. Kelly Gerard Joseph Abou Jaoude Tom Palmer Jolene Skordis Hassan Haghparast-Bidgoli Lara Goscé Sarah J. Jarvis David J. Kedziora Romesh Abeysuriya Clemens Benedikt Nicole Fraser-Hurt Zara Shubber Nejma Cheikh Stela Bivol Anna Roberts David P. Wilson Rowan Martin-Hughes Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and Romania PLOS Global Public Health |
| title | Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and Romania |
| title_full | Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and Romania |
| title_fullStr | Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and Romania |
| title_full_unstemmed | Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and Romania |
| title_short | Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and Romania |
| title_sort | public health benefits of shifting from hospital focused to ambulatory tb care in eastern europe optimising tb investments in belarus the republic of moldova and romania |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10284374/?tool=EBI |
| work_keys_str_mv | AT sherrielkelly publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT gerardjosephaboujaoude publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT tompalmer publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT joleneskordis publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT hassanhaghparastbidgoli publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT laragosce publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT sarahjjarvis publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT davidjkedziora publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT romeshabeysuriya publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT clemensbenedikt publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT nicolefraserhurt publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT zarashubber publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT nejmacheikh publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT stelabivol publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT annaroberts publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT davidpwilson publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania AT rowanmartinhughes publichealthbenefitsofshiftingfromhospitalfocusedtoambulatorytbcareineasterneuropeoptimisingtbinvestmentsinbelarustherepublicofmoldovaandromania |