Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods
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-effecti...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-02-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/8/2/e010306.full |
| _version_ | 1797791049442131968 |
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| author | Richard G White Karina Kielmann Karin Diaconu Anna Vassall Alison D Grant Fiammetta Maria Bozzani Nicky McCreesh Indira Govender |
| author_facet | Richard G White Karina Kielmann Karin Diaconu Anna Vassall Alison D Grant Fiammetta Maria Bozzani Nicky McCreesh Indira Govender |
| author_sort | Richard G White |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T02:13:15Z |
| format | Article |
| id | doaj.art-99a093f41df9436d85a9c7976e5ad794 |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-03-13T02:13:15Z |
| publishDate | 2023-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-99a093f41df9436d85a9c7976e5ad7942023-06-30T20:00:07ZengBMJ Publishing GroupBMJ Global Health2059-79082023-02-018210.1136/bmjgh-2022-010306Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methodsRichard G White0Karina Kielmann1Karin Diaconu2Anna Vassall3Alison D Grant4Fiammetta Maria Bozzani5Nicky McCreesh6Indira Govender7TB Centre, London School of Hygiene & Tropical Medicine, London, UKInstitute of Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UKInstitute of Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UKDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKTB Centre, London School of Hygiene & Tropical Medicine, London, UKDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKTB Centre, London School of Hygiene & Tropical Medicine, London, UKTB Centre, London School of Hygiene & Tropical Medicine, London, UKIntroduction 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.https://gh.bmj.com/content/8/2/e010306.full |
| spellingShingle | Richard G White Karina Kielmann Karin Diaconu Anna Vassall Alison D Grant Fiammetta Maria Bozzani Nicky McCreesh Indira Govender Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods BMJ Global Health |
| title | Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods |
| title_full | Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods |
| title_fullStr | Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods |
| title_full_unstemmed | Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods |
| title_short | Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods |
| title_sort | cost effectiveness of tuberculosis infection prevention and control interventions in south african clinics a model based economic evaluation informed by complexity science methods |
| url | https://gh.bmj.com/content/8/2/e010306.full |
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