Cost-effectiveness and budget impact of decentralising childhood tuberculosis diagnosis in six high tuberculosis incidence countries: a mathematical modelling study
| dc.rights.license | open | en_US |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| hal.structure.identifier | Global Health in the Global South [GHiGS] | |
| dc.contributor.author | D'ELBEE, Marc | |
| dc.contributor.author | HARKER, Martin | |
| dc.contributor.author | MAFIRAKUREVA, Nyashadzaishe | |
| dc.contributor.author | NANFUKA, Mastula | |
| dc.contributor.author | HUYEN TON NU NGUYET, Minh | |
| dc.contributor.author | TAGUEBUE, Jean-Voisin | |
| dc.contributor.author | MOH, Raoul | |
| dc.contributor.author | KHOSA, Celso | |
| dc.contributor.author | MUSTAPHA, Ayeshatu | |
| dc.contributor.author | MWANGA-AMUMPERE, Juliet | |
| dc.contributor.author | BORAND, Laurence | |
| dc.contributor.author | NOLNA, Sylvie Kwedi | |
| dc.contributor.author | KOMENA, Eric | |
| dc.contributor.author | CUMBE, Saniata | |
| dc.contributor.author | MUGISHA, Jacob | |
| dc.contributor.author | NATUKUNDA, Naome | |
| dc.contributor.author | MAO, Tan Eang | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | WITTWER, Jerome | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | BENARD, Antoine | |
| dc.contributor.author | BERNARD, Tanguy
IDREF: 186182163 | |
| dc.contributor.author | SOHN, Hojoon | |
| dc.contributor.author | BONNET, Maryline | |
| dc.contributor.author | WOBUDEYA, Eric | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| hal.structure.identifier | Global Health in the Global South [GHiGS] | |
| dc.contributor.author | MARCY, Olivier | |
| dc.contributor.author | DODD, Peter J | |
| dc.date.accessioned | 2024-06-19T14:06:44Z | |
| dc.date.available | 2024-06-19T14:06:44Z | |
| dc.date.issued | 2024-04-01 | |
| dc.identifier.issn | 2589-5370 | en_US |
| dc.identifier.uri | https://oskar-bordeaux.fr/handle/20.500.12278/200578 | |
| dc.description.abstractEn | BACKGROUND: The burden of childhood tuberculosis remains high globally, largely due to under-diagnosis. Decentralising childhood tuberculosis diagnosis services to lower health system levels could improve case detection, but there is little empirically based evidence on cost-effectiveness or budget impact. METHODS: In this mathematical modelling study, we assessed the cost-effectiveness and budget impact of decentralising a comprehensive diagnosis package for childhood tuberculosis to district hospitals (DH-focused) or primary health centres (PHC-focused) compared to standard of care (SOC). The project was conducted in Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Sierra Leone, and Uganda between August 1st, 2018 and September 30th, 2021. A mathematical model was developed to assess the health and economic outcomes of the intervention from a health system perspective. Estimated outcomes were tuberculosis cases, deaths, disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (ICERs). We also calculated the budget impact of nationwide implementation. The TB-Speed Decentralization study is registered with ClinicalTrials.gov, NCT04038632. FINDINGS: For the DH-focused strategy versus SOC, ICERs ranged between $263 (Cambodia) and $342 (Côte d'Ivoire) per DALY averted. For the PHC-focused strategy versus SOC, ICERs ranged between $477 (Cambodia) and $599 (Côte d'Ivoire) per DALY averted. Results were sensitive to TB prevalence and the discount rate used. The additional costs of implementing the DH-focused strategy ranged between $12.8 M (range 10.8-16.4) (Cambodia) and $50.4 M (36.5-74.4) (Mozambique), and between $13.9 M (12.6-15.6) (Sierra Leone) and $134.6 M (127.1-143.0) (Uganda) for the PHC-focused strategy. INTERPRETATION: The DH-focused strategy may be cost-effective in some countries, depending on the cost-effectiveness threshold used for policy making. Either intervention would require substantial early investment. FUNDING: Unitaid. | |
| dc.language.iso | EN | en_US |
| dc.rights | Attribution 3.0 United States | * |
| dc.rights.uri | http://creativecommons.org/licenses/by/3.0/us/ | * |
| dc.subject.en | Decentralisation | |
| dc.subject.en | Diagnosis | |
| dc.subject.en | Economic evaluation | |
| dc.subject.en | Low- and middle-income countries | |
| dc.subject.en | Paediatric tuberculosis | |
| dc.title.en | Cost-effectiveness and budget impact of decentralising childhood tuberculosis diagnosis in six high tuberculosis incidence countries: a mathematical modelling study | |
| dc.title.alternative | EClinicalMedicine | en_US |
| dc.type | Article de revue | en_US |
| dc.identifier.doi | 10.1016/j.eclinm.2024.102528 | en_US |
| dc.subject.hal | Sciences du Vivant [q-bio]/Santé publique et épidémiologie | en_US |
| dc.identifier.pubmed | 38685930 | en_US |
| bordeaux.journal | EClinicalMedicine | en_US |
| bordeaux.page | 102528 | en_US |
| bordeaux.volume | 70 | en_US |
| bordeaux.hal.laboratories | Bordeaux Population Health Research Center (BPH) - UMR 1219 | en_US |
| bordeaux.institution | Université de Bordeaux | en_US |
| bordeaux.institution | INSERM | en_US |
| bordeaux.team | GHIGS_BPH | en_US |
| bordeaux.team | PHARES_BPH | en_US |
| bordeaux.peerReviewed | oui | en_US |
| bordeaux.inpress | non | en_US |
| bordeaux.identifier.funderID | Institut de Recherche pour le Développement | en_US |
| hal.popular | non | en_US |
| hal.audience | Internationale | en_US |
| hal.export | false | |
| dc.rights.cc | Pas de Licence CC | en_US |
| bordeaux.COinS | ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=EClinicalMedicine&rft.date=2024-04-01&rft.volume=70&rft.spage=102528&rft.epage=102528&rft.eissn=2589-5370&rft.issn=2589-5370&rft.au=D'ELBEE,%20Marc&HARKER,%20Martin&MAFIRAKUREVA,%20Nyashadzaishe&NANFUKA,%20Mastula&HUYEN%20TON%20NU%20NGUYET,%20Minh&rft.genre=article |
