scholarly journals The cost-effectiveness of incentive-based active case finding for tuberculosis (TB) control in the private sector Karachi, Pakistan

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hamidah Hussain ◽  
Amani Thomas Mori ◽  
Aamir J. Khan ◽  
Saira Khowaja ◽  
Jacob Creswell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Private Sector ◽  
Health Sector ◽  
Cost Effective ◽  
Case Finding ◽  
Active Case Finding ◽  
Tree Model ◽  
Active Case ◽  
Tb Control ◽  
The Cost

Abstract Background In Asia, over 50% of patients with symptoms of tuberculosis (TB) access health care from private providers. These patients are usually not notified to the National TB Control Programs, which contributes to low notification rates in many countries. Methods From January 1, 2011 to December 31, 2012, Karachi’s Indus Hospital - a private sector partner to the National TB Programme - engaged 80 private family clinics in its catchment area in active case finding using health worker incentives to increase notification of TB disease. The costs incurred were estimated from the perspective of patients, health facility and the program providing TB services. A Markov decision tree model was developed to calculate the cost-effectiveness of the active case finding as compared to case detection through the routine passive TB centers. Pakistan has a large private health sector, which can be mobilized for TB screening using an incentivized active case finding strategy. Currently, TB screening is largely performed in specialist public TB centers through passive case finding. Active and passive case finding strategies are assumed to operate independently from each other. Results The incentive-based active case finding program costed USD 223 per patient treated. In contrast, the center based non-incentive arm was 23.4% cheaper, costing USD 171 per patient treated. Cost-effectiveness analysis showed that the incentive-based active case finding program was more effective and less expensive per DALY averted when compared to the baseline passive case finding as it averts an additional 0.01966 DALYs and saved 15.74 US$ per patient treated. Conclusion Both screening strategies appear to be cost-effective in an urban Pakistan context. Incentive driven active case findings of TB in the private sector costs less and averts more DALYs per health seeker than passive case finding, when both alternatives are compared to a common baseline situation of no screening.

scholarly journals Correction to: The cost-effectiveness of incentive-based active case finding for tuberculosis (TB) control in the private sector Karachi, Pakistan

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hamidah Hussain ◽  
Amani Thomas Mori ◽  
Aamir J. Khan ◽  
Saira Khowaja ◽  
Jacob Creswell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Private Sector ◽  
Case Finding ◽  
Active Case Finding ◽  
Original Publication ◽  
Active Case ◽  
Tb Control ◽  
The Cost

In the original publication of this article [1], an author’s name needs to be revised from Jacob Creswel to Jacob Creswell.

scholarly journals Cost-effectiveness of active case-finding of household contacts of pulmonary tuberculosis patients in a low HIV, tuberculosis-endemic urban area of Lima, Peru

2017 ◽  
Vol 145 (6) ◽  
pp. 1107-1117 ◽  
Author(s):  
L. SHAH ◽  
M. ROJAS ◽  
O. MORI ◽  
C. ZAMUDIO ◽  
J. S. KAUFMAN ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Test ◽  
Cost Effective ◽  
Case Finding ◽  
Self Report ◽  
Urban Setting ◽  
Active Case Finding ◽  
Active Case ◽  
Household Contacts ◽  
Life Years

SUMMARYWe compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.

P14.41 Cost-effectiveness of FET PET for early treatment response assessment in glioma patients following adjuvant temozolomide chemotherapy

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii46-ii46
Author(s):  
J Rosen ◽  
G Ceccon ◽  
E K Bauer ◽  
J M Werner ◽  
C Kabbasch ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Response Assessment ◽  
Sensitivity Analyses ◽  
Tree Model ◽  
Fet Pet ◽  
Conventional Mri ◽  
Adjuvant Temozolomide ◽  
The Cost ◽  
Temozolomide Chemotherapy

Abstract BACKGROUND In light of increasing healthcare costs, higher medical expenses should be justified socio-economically. Therefore, we calculated the effectiveness and cost-effectiveness of PET using the radiolabeled amino acid O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) compared to conventional MRI for early identification of responders to adjuvant temozolomide chemotherapy. A recent study in IDH-wildtype glioma patients suggested that after two cycles, FET-PET parameter changes predicted a significantly longer survival while MRI changes were not significant. MATERIALS AND METHODS To determine the effectiveness and cost-effectiveness of serial FET-PET imaging, we analyzed published clinical data and calculated the associated costs in the context of the German healthcare system.Based on a decision-tree model, FET-PET and MRI’s effectiveness was calculated, i.e., the probability to correctly identify a responder as defined by an overall survival ≥15 months. To determine the cost-effectiveness, the incremental cost-effectiveness ratio (ICER) was calculated, i.e., the cost for each additionally identified responder by FET-PET who would have remained undetected by MRI. The robustness of the results was tested by deterministic and probabilistic (Monte Carlo simulation) sensitivity analyses. RESULTS Compared to MRI, FET-PET increases the rate of correctly identified responders to chemotherapy by 26%; thus, four patients need to be examined by FET-PET to identify one additional responder. Considering the respective cost for serial FET-PET and MRI, the ICER resulted in €4,396.83 for each additional correctly identified responder by FET-PET. The sensitivity analyses confirmed the robustness of the results. CONCLUSION In contrast to conventional MRI, the model suggests that FET PET is cost-effective in terms of ICER values. Concerning the high cost of temozolomide, the integration of FET-PET has the potential to avoid premature chemotherapy discontinuation at a reasonable cost.

scholarly journals A Cost-Effectiveness Analysis of Newborn Screening for Severe Combined Immunodeficiency in the UK

2019 ◽  
Vol 5 (3) ◽  
pp. 28 ◽  
Author(s):  
Alice Bessey ◽  
James Chilcott ◽  
Joanna Leaviss ◽  
Carmen de la Cruz ◽  
Ruth Wong
Keyword(s):  
Cost Effectiveness ◽  
Severe Combined Immunodeficiency ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Combined Immunodeficiency ◽  
Tree Model ◽  
Life Years ◽  
The Uk ◽  
The Cost ◽  
The Impact

Severe combined immunodeficiency (SCID) can be detected through newborn bloodspot screening. In the UK, the National Screening Committee (NSC) requires screening programmes to be cost-effective at standard UK thresholds. To assess the cost-effectiveness of SCID screening for the NSC, a decision-tree model with lifetable estimates of outcomes was built. Model structure and parameterisation were informed by systematic review and expert clinical judgment. A public service perspective was used and lifetime costs and quality-adjusted life years (QALYs) were discounted at 3.5%. Probabilistic, one-way sensitivity analyses and an exploratory disbenefit analysis for the identification of non-SCID patients were conducted. Screening for SCID was estimated to result in an incremental cost-effectiveness ratio (ICER) of £18,222 with a reduction in SCID mortality from 8.1 (5–12) to 1.7 (0.6–4.0) cases per year of screening. Results were sensitive to a number of parameters, including the cost of the screening test, the incidence of SCID and the disbenefit to the healthy at birth and false-positive cases. Screening for SCID is likely to be cost-effective at £20,000 per QALY, key uncertainties relate to the impact on false positives and the impact on the identification of children with non-SCID T Cell lymphopenia.

scholarly journals The Cost-effectiveness of Biological Therapy Cycles in the Management of Crohn’s Disease

2019 ◽  
Vol 13 (10) ◽  
pp. 1323-1333 ◽  
Author(s):  
Kristian Bolin ◽  
Erik Hertervig ◽  
Edouard Louis
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Willingness To Pay ◽  
Cost Effective ◽  
Treatment Intensification ◽  
Tree Model ◽  
Necrosis Factor Alpha ◽  
The Cost

Abstract Objectives To examine the cost-effectiveness of continued treatment for patients with moderate-severe Crohn’s disease in clinical remission, with a combination of anti-tumour necrosis factor alpha [anti-TNFα] [infliximab] and immunomodulator therapy compared with two different withdrawal strategies: [1] withdrawal of the anti-TNFα therapy; and [2] withdrawal of the immunomodulator therapy, respectively. Methods A decision-tree model was constructed mimicking three treatment arms: [1] continued combination therapy with infliximab and immunomodulator; [2] withdrawal of infliximab; or [3] withdrawal of the immunomodulator. Relapses in each arm are managed with treatment intensification and re-institution of the de-escalated drug according to a prespecified algorithm. State-dependent relapse risks, remission probabilities, and quality of life weights were collected from previous published studies. Results Combination therapy was less costly and more efficient than the withdrawal of the immunomodulator, and more costly and more efficient than withdrawal of infliximab. Whether or not combination therapy is cost-effective, compared with the alternatives, depends primarily on current pharmaceutical prices and the willingness-to-pay per additional quality-adjusted life-year [QALY]. Conclusions Combination therapy using a combination of anti-TNFα [infliximab] and an immunomodulator is cost-effective in the treatment of Crohn’s disease compared with treatment cycles in which the immunomodulator is withdrawn. Combination treatment is cost-effective compared with treatment cycles in which infliximab is withdrawn, at prices of infliximab below€192/100 mg, given a willingness-to-pay threshold at€49 020 [Sweden] per additional QALY.

scholarly journals Comparison of yield and relative costs of different screening algorithms for tuberculosis in active case-finding: a cross-section study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Zhao ◽  
Canyou Zhang ◽  
Chongguang Yang ◽  
Yinyin Xia ◽  
Jin Xing ◽  
...  
Keyword(s):  
Case Finding ◽  
Active Case Finding ◽  
Face To Face ◽  
Active Case ◽  
Symptom Screening ◽  
Significant Difference ◽  
National Tuberculosis ◽  
Study Population ◽  
The Difference ◽  
The Cost

Abstract Background Part of tuberculosis (TB) patients were missed if symptomatic screening was based on the main TB likely symptoms. This study conducted to compare the yield and relative costs of different TB screening algorithms in active case-finding in the whole population in China. Methods The study population was screened based on the TB likely symptoms through a face-to-face interview in selected 27 communities from 10 counties of 10 provinces in China. If the individuals had any of the enhanced TB likely symptoms, both chest X-ray and sputum tests were carried out for them furtherly. We used the McNemar test to analyze the difference in TB detection among four algorithms in active case-finding. Of four algorithms, two were from WHO recommendations including 1a/1c, one from China National Tuberculosis Program, and one from this study with the enhanced TB likely symptoms. Furthermore, a two-way ANOVA analysis was performed to analyze the cost difference in the performance of active case-finding adjusted by different demographic and health characteristics among different algorithms. Results Algorithm with the enhanced TB likely symptoms defined in this study could increase the yield of TB detection in active case-finding, compared with algorithms recommended by WHO (p < 0.01, Kappa 95% CI: 0. 93–0.99) and China NTP (p = 0.03, Kappa 95% CI: 0.96–1.00). There was a significant difference in the total costs among different three algorithms WHO 1c/2/3 (F = 59.13, p < 0.01). No significant difference in the average costs for one active TB case screened and diagnosed through the process among Algorithms 1c/2/3 was evident (F = 2.78, p = 0.07). The average costs for one bacteriological positive case through algorithm WHO 1a was about two times as much as the costs for one active TB case through algorithms WHO 1c/2/3. Conclusions Active case-finding based on the enhanced symptom screening is meaningful for TB case-finding and it could identify more active TB cases in time. The findings indicated that this enhanced screening approach cost more compared to algorithms recommend by WHO and China NTP, but the increased yield resulted in comparative costs per patient. And it cost much more that only smear/bacteriological-positive TB cases are screened in active case-finding.

scholarly journals Economic Analysis of the CLIP Trials in India, Pakistan and Mozambique

2020 ◽  
Author(s):  
Jeffrey N Bone ◽  
Asif Khowaja ◽  
Marianne Vidler ◽  
Beth A. Payne ◽  
Mrutyunjaya B Bellad ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Workers ◽  
Cost Effective ◽  
World Health ◽  
Years Of Life Lost ◽  
Tree Model ◽  
Pregnancy Hypertension ◽  
Contact Frequency ◽  
Health Organization ◽  
The Cost

Abstract Background: The Community-Level Interventions for Pre-eclampsia (CLIP) Trials (NCT01911494) in India, Pakistan, and Mozambique (February 2014-7) involved community engagement and task-sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the costs and cost-effectiveness of the CLIP intervention overall, and by POM visit frequency. Methods: Included were all women enrolled in the three CLIP trials who had delivered with known outcomes by trial end. According to the number of POM-guided home contacts received (0, 1-3, 4-7, ³8), costs were collected from annual budgets and spending receipts, with inclusion of family opportunity costs in Pakistan. A decision-tree model was built to determine the cost-effectiveness of the intervention (vs. usual care), based on the primary clinical endpoint of years-of-life-lost (YLL) for mothers and infants. A probabilistic sensitivity analysis was used to assess uncertainty in the cost and clinical outcomes.Results: The incremental per pregnancy cost of the intervention was USD$12.66 (India), USD$11.51 (Pakistan) and USD$13.26 (Mozambique). As implemented, the intervention was not cost-effective, due largely to minimal differences in years-of-life-lost between arms. However, among women who received ≥8 contacts (4 in Pakistan), the probability of health system and family (Pakistan) cost-effectiveness was ≥80% (all countries). Conclusion: The intervention was likely to be cost-effective for women receiving ≥8 contacts in Mozambique and India, and ≥4 in Pakistan, supporting World Health Organization guidance on antenatal contact frequency.Funding: The University of British Columbia, a grantee of the Bill & Melinda Gates Foundation (OPP1017337).Trial registration: clinicaltrials.gov. Registered 30 July 2013, https://clinicaltrials.gov/ct2/show/NCT01911494

scholarly journals Cost-effectiveness of a Pharmacogenomic Test for Stratified Isoniazid Dosing in Treatment of Active Tuberculosis

2020 ◽  
Author(s):  
Neil E Rens ◽  
Carin A Uyl-de Groot ◽  
Jeremy D Goldhaber-Fiebert ◽  
Julio Croda ◽  
Jason R Andrews
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Tree Model ◽  
A Value ◽  
Life Years ◽  
Nat2 Gene ◽  
Potential Clinical Impact ◽  
The Cost

Abstract Background There is marked interindividual variability in metabolism and resulting toxicity and effectiveness of drugs used for tuberculosis treatment. For isoniazid, mutations in the N-acetyltransferase 2 (NAT2) gene explain &gt;88% of pharmacokinetic variability. However, weight-based dosing remains the norm globally. The potential clinical impact and cost-effectiveness of pharmacogenomic-guided therapy (PGT) are unknown. Methods We constructed a decision tree model to project lifetime costs and benefits of isoniazid PGT for drug-susceptible tuberculosis in Brazil, South Africa, and India. PGT was modeled to reduce isoniazid toxicity among slow NAT2 acetylators and reduce treatment failure among rapid acetylators. The genotyping test was assumed to cost the same as the GeneXpert test. The main outcomes were costs (2018 US dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Results In Brazil, PGT gained 19 discounted life-years (23 QALYs) and cost $11 064 per 1000 patients, a value of $476 per QALY gained. In South Africa, PGT gained 15 life-years (19 QALYs) and cost $33 182 per 1000 patients, a value of $1780 per QALY gained. In India, PGT gained 20 life-years (24 QALYs) and cost $13 195 per 1000 patients, a value of $546 per QALY gained. One-way sensitivity analyses showed the cost-effectiveness to be robust to all input parameters. Probabilistic sensitivity analyses were below per capita gross domestic product in all 3 countries in 99% of simulations. Conclusions Isoniazid PGT improves health outcomes and would be cost-effective in the treatment of drug-susceptible tuberculosis in Brazil, South Africa, and India.

scholarly journals Pharmacoeconomics of three therapeutic schemes for anti-tuberculosis therapy induced liver injury in China

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 53-63 ◽  
Author(s):  
Yu Chen ◽  
Peng Ye ◽  
Chongwu Ren ◽  
Pengfei Ren ◽  
Zheng Ma ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Liver Injury ◽  
Controlled Trial ◽  
Cost Effective ◽  
Unit Price ◽  
Sensitivity Analyses ◽  
Expert Advice ◽  
Cost Effectiveness Ratio ◽  
Tree Model ◽  
The Cost

AbstractTo evaluate the pharmacoeconomics of three therapeutic schemes in treating anti-tuberluosis therapy -induced liver injury (anti-TB DILI).MethodsIn the construction of a decision tree model, the efficacy and safety parameters came from the results of the randomized, controlled trial conducted here, the effect parameters were derived from expert advice, and the cost parameters, such as usage specification, number, and unit price, came from literature, expert advice, and so on.ResultsThe cost-effectiveness analysis (CEA) based on the effect degrees showed that bicyclol had the best effect (4.63562). The incremental cost-effectiveness ratio (ICER) (206.03270) of bicyclol was the lowest. The cost-effectiveness ratio of silibinin was the lowest (68.59987). The CEA based on the complete normalization rate showed that bicyclol had the highest complete normalization rate (83.562%), the lowest cost-effectiveness ratio (4.63627), and the smallest ICER (4.63504). Sensitivity analyses proved the robustness of the results.ConclusionsBicyclol is the most cost-effective therapy and the preferred choice for treating anti-TB DILI.

Sign in / Sign up

Export Citation Format

Share Document