Empirical estimation of resource constraints for use in model-based economic evaluation: an example of TB services in South Africa
Abstract Background Evidence on the relative costs and effects of interventions that do not consider ‘real-world’ constraints on implementation may be misleading. However, in many low- and middle-income countries, time and data scarcity mean that incorporating health system constraints in priority s...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-07-01
|
| Series: | Cost Effectiveness and Resource Allocation |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12962-018-0113-z |
| _version_ | 1818451288168333312 |
|---|---|
| author | Fiammetta M. Bozzani Don Mudzengi Tom Sumner Gabriela B. Gomez Piotr Hippner Vicky Cardenas Salome Charalambous Richard White Anna Vassall |
| author_facet | Fiammetta M. Bozzani Don Mudzengi Tom Sumner Gabriela B. Gomez Piotr Hippner Vicky Cardenas Salome Charalambous Richard White Anna Vassall |
| author_sort | Fiammetta M. Bozzani |
| collection | DOAJ |
| description | Abstract Background Evidence on the relative costs and effects of interventions that do not consider ‘real-world’ constraints on implementation may be misleading. However, in many low- and middle-income countries, time and data scarcity mean that incorporating health system constraints in priority setting can be challenging. Methods We developed a ‘proof of concept’ method to empirically estimate health system constraints for inclusion in model-based economic evaluations, using intensified case-finding strategies (ICF) for tuberculosis (TB) in South Africa as an example. As part of a strategic planning process, we quantified the resources (fiscal and human) needed to scale up different ICF strategies (cough triage and WHO symptom screening). We identified and characterised three constraints through discussions with local stakeholders: (1) financial constraint: potential maximum increase in public TB financing available for new TB interventions; (2) human resource constraint: maximum current and future capacity among public sector nurses that could be dedicated to TB services; and (3) diagnostic supplies constraint: maximum ratio of Xpert MTB/RIF tests to TB notifications. We assessed the impact of these constraints on the costs of different ICF strategies. Results It would not be possible to reach the target coverage of ICF (as defined by policy makers) without addressing financial, human resource and diagnostic supplies constraints. The costs of addressing human resource constraints is substantial, increasing total TB programme costs during the period 2016–2035 by between 7% and 37% compared to assuming the expansion of ICF is unconstrained, depending on the ICF strategy chosen. Conclusions Failure to include the costs of relaxing constraints may provide misleading estimates of costs, and therefore cost-effectiveness. In turn, these could impact the local relevance and credibility of analyses, thereby increasing the risk of sub-optimal investments. |
| first_indexed | 2024-12-14T21:04:49Z |
| format | Article |
| id | doaj.art-a85819f045c34e57a390cf1fd716df7a |
| institution | Directory Open Access Journal |
| issn | 1478-7547 |
| language | English |
| last_indexed | 2024-12-14T21:04:49Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj.art-a85819f045c34e57a390cf1fd716df7a2022-12-21T22:47:30ZengBMCCost Effectiveness and Resource Allocation1478-75472018-07-0116111010.1186/s12962-018-0113-zEmpirical estimation of resource constraints for use in model-based economic evaluation: an example of TB services in South AfricaFiammetta M. Bozzani0Don Mudzengi1Tom Sumner2Gabriela B. Gomez3Piotr Hippner4Vicky Cardenas5Salome Charalambous6Richard White7Anna Vassall8Department of Global Health and Development, London School of Hygiene & Tropical MedicineThe Aurum InstituteTB Modelling Group, TB Centre, CMMID, London School of Hygiene & Tropical MedicineDepartment of Global Health and Development, London School of Hygiene & Tropical MedicineThe Aurum InstituteThe Aurum InstituteTB Modelling Group, TB Centre, CMMID, London School of Hygiene & Tropical MedicineTB Modelling Group, TB Centre, CMMID, London School of Hygiene & Tropical MedicineDepartment of Global Health and Development, London School of Hygiene & Tropical MedicineAbstract Background Evidence on the relative costs and effects of interventions that do not consider ‘real-world’ constraints on implementation may be misleading. However, in many low- and middle-income countries, time and data scarcity mean that incorporating health system constraints in priority setting can be challenging. Methods We developed a ‘proof of concept’ method to empirically estimate health system constraints for inclusion in model-based economic evaluations, using intensified case-finding strategies (ICF) for tuberculosis (TB) in South Africa as an example. As part of a strategic planning process, we quantified the resources (fiscal and human) needed to scale up different ICF strategies (cough triage and WHO symptom screening). We identified and characterised three constraints through discussions with local stakeholders: (1) financial constraint: potential maximum increase in public TB financing available for new TB interventions; (2) human resource constraint: maximum current and future capacity among public sector nurses that could be dedicated to TB services; and (3) diagnostic supplies constraint: maximum ratio of Xpert MTB/RIF tests to TB notifications. We assessed the impact of these constraints on the costs of different ICF strategies. Results It would not be possible to reach the target coverage of ICF (as defined by policy makers) without addressing financial, human resource and diagnostic supplies constraints. The costs of addressing human resource constraints is substantial, increasing total TB programme costs during the period 2016–2035 by between 7% and 37% compared to assuming the expansion of ICF is unconstrained, depending on the ICF strategy chosen. Conclusions Failure to include the costs of relaxing constraints may provide misleading estimates of costs, and therefore cost-effectiveness. In turn, these could impact the local relevance and credibility of analyses, thereby increasing the risk of sub-optimal investments.http://link.springer.com/article/10.1186/s12962-018-0113-zConstraintsEconomic evaluationMathematical modellingHealth systemsTuberculosisSouth Africa |
| spellingShingle | Fiammetta M. Bozzani Don Mudzengi Tom Sumner Gabriela B. Gomez Piotr Hippner Vicky Cardenas Salome Charalambous Richard White Anna Vassall Empirical estimation of resource constraints for use in model-based economic evaluation: an example of TB services in South Africa Cost Effectiveness and Resource Allocation Constraints Economic evaluation Mathematical modelling Health systems Tuberculosis South Africa |
| title | Empirical estimation of resource constraints for use in model-based economic evaluation: an example of TB services in South Africa |
| title_full | Empirical estimation of resource constraints for use in model-based economic evaluation: an example of TB services in South Africa |
| title_fullStr | Empirical estimation of resource constraints for use in model-based economic evaluation: an example of TB services in South Africa |
| title_full_unstemmed | Empirical estimation of resource constraints for use in model-based economic evaluation: an example of TB services in South Africa |
| title_short | Empirical estimation of resource constraints for use in model-based economic evaluation: an example of TB services in South Africa |
| title_sort | empirical estimation of resource constraints for use in model based economic evaluation an example of tb services in south africa |
| topic | Constraints Economic evaluation Mathematical modelling Health systems Tuberculosis South Africa |
| url | http://link.springer.com/article/10.1186/s12962-018-0113-z |
| work_keys_str_mv | AT fiammettambozzani empiricalestimationofresourceconstraintsforuseinmodelbasedeconomicevaluationanexampleoftbservicesinsouthafrica AT donmudzengi empiricalestimationofresourceconstraintsforuseinmodelbasedeconomicevaluationanexampleoftbservicesinsouthafrica AT tomsumner empiricalestimationofresourceconstraintsforuseinmodelbasedeconomicevaluationanexampleoftbservicesinsouthafrica AT gabrielabgomez empiricalestimationofresourceconstraintsforuseinmodelbasedeconomicevaluationanexampleoftbservicesinsouthafrica AT piotrhippner empiricalestimationofresourceconstraintsforuseinmodelbasedeconomicevaluationanexampleoftbservicesinsouthafrica AT vickycardenas empiricalestimationofresourceconstraintsforuseinmodelbasedeconomicevaluationanexampleoftbservicesinsouthafrica AT salomecharalambous empiricalestimationofresourceconstraintsforuseinmodelbasedeconomicevaluationanexampleoftbservicesinsouthafrica AT richardwhite empiricalestimationofresourceconstraintsforuseinmodelbasedeconomicevaluationanexampleoftbservicesinsouthafrica AT annavassall empiricalestimationofresourceconstraintsforuseinmodelbasedeconomicevaluationanexampleoftbservicesinsouthafrica |