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Cost-effectiveness and budget impact of decentralising childhood tuberculosis diagnosis in six high tuberculosis incidence countries: a mathematical modelling study

dc.rights.licenseopenen_US
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorD'ELBEE, Marc
dc.contributor.authorHARKER, Martin
dc.contributor.authorMAFIRAKUREVA, Nyashadzaishe
dc.contributor.authorNANFUKA, Mastula
dc.contributor.authorHUYEN TON NU NGUYET, Minh
dc.contributor.authorTAGUEBUE, Jean-Voisin
dc.contributor.authorMOH, Raoul
dc.contributor.authorKHOSA, Celso
dc.contributor.authorMUSTAPHA, Ayeshatu
dc.contributor.authorMWANGA-AMUMPERE, Juliet
dc.contributor.authorBORAND, Laurence
dc.contributor.authorNOLNA, Sylvie Kwedi
dc.contributor.authorKOMENA, Eric
dc.contributor.authorCUMBE, Saniata
dc.contributor.authorMUGISHA, Jacob
dc.contributor.authorNATUKUNDA, Naome
dc.contributor.authorMAO, Tan Eang
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorWITTWER, Jerome
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorBENARD, Antoine
dc.contributor.authorBERNARD, Tanguy
IDREF: 186182163
dc.contributor.authorSOHN, Hojoon
dc.contributor.authorBONNET, Maryline
dc.contributor.authorWOBUDEYA, Eric
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorMARCY, Olivier
dc.contributor.authorDODD, Peter J
dc.date.accessioned2024-06-19T14:06:44Z
dc.date.available2024-06-19T14:06:44Z
dc.date.issued2024-04-01
dc.identifier.issn2589-5370en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/200578
dc.description.abstractEnBACKGROUND: 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.isoENen_US
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.subject.enDecentralisation
dc.subject.enDiagnosis
dc.subject.enEconomic evaluation
dc.subject.enLow- and middle-income countries
dc.subject.enPaediatric tuberculosis
dc.title.enCost-effectiveness and budget impact of decentralising childhood tuberculosis diagnosis in six high tuberculosis incidence countries: a mathematical modelling study
dc.title.alternativeEClinicalMedicineen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1016/j.eclinm.2024.102528en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed38685930en_US
bordeaux.journalEClinicalMedicineen_US
bordeaux.page102528en_US
bordeaux.volume70en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamGHIGS_BPHen_US
bordeaux.teamPHARES_BPHen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
bordeaux.identifier.funderIDInstitut de Recherche pour le Développementen_US
hal.popularnonen_US
hal.audienceInternationaleen_US
hal.exportfalse
dc.rights.ccPas de Licence CCen_US
bordeaux.COinSctx_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


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