scholarly journals A Systematic Review of Economic Evaluations of Active Tuberculosis Treatments

2021 ◽  
Vol 12 ◽  
Author(s):  
Joo-Young Byun ◽  
Hye-Lin Kim ◽  
Eui-Kyung Lee ◽  
Sun-Hong Kwon
Keyword(s):  
Systematic Review ◽  
Primary Outcome ◽  
Cost Effective ◽  
Multidrug Resistant ◽  
Active Tuberculosis ◽  
Economic Evaluations ◽  
Middle Income ◽  
Middle Income Countries ◽  
Life Years ◽  
Decentralized Care

Background: The disease burden of active tuberculosis (TB) is considerable, but systematic reviews of economic evaluations of active TB treatments are scarce.Methods: PubMed, EMBASE, and the Cochrane Library databases were used to search for articles on cost-effectiveness analysis or cost-utility analysis that economically evaluated active TB treatments, which were then systematically reviewed by two independent reviewers. We extracted vital components of the included studies, such as country, population, intervention/comparator, primary outcome, values of outcomes, thresholds, model type, time horizon, and health states included in the model.Results: Seventeen studies were included in this systematic review. Thirteen dealt with interventions of medications, and the remaining four compared care strategies. The Markov model was the most commonly used tool to compare medications, whereas studies on care plans mainly used decision trees. The most commonly used primary outcome was disability-adjusted life years, followed by quality-adjusted life years. For treatment-naïve TB, the 4-month regimen was more cost-effective than the 6-month regimen mainly in low- and middle-income countries. For multidrug-resistant TB, a bedaquiline-based regimen was cost-effective. For multidrug-resistant TB, decentralized care that employed the use of home or mobile devices was more cost-effective than hospital-based centralized care in low- and middle-income countries.Conclusion: New treatment strategies to improve therapeutic outcomes by enhancing treatment adherence, such as regimens with shorter durations (2 or 4 months) and decentralized care, or new anti-TB agents (e.g., bedaquiline) have been suggested as cost-effective interventions for active TB. This review provides information on the economic evaluation of active TB from good-quality studies, thus aiding the future economic evaluation of active TB.

scholarly journals Cost of maternal health services in low and middle-income countries: protocol for a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027822 ◽  
Author(s):  
Aduragbemi Banke-Thomas ◽  
Ibukun-Oluwa Omolade Abejirinde ◽  
Oluwasola Banke-Thomas ◽  
Adamu Maikano ◽  
Charles Anawo Ameh
Keyword(s):  
Systematic Review ◽  
Maternal Health ◽  
Health Service ◽  
Health Services ◽  
Maternal Health Services ◽  
Maternal Health Service ◽  
Economic Evaluations ◽  
Middle Income ◽  
Health Service Provision ◽  
Middle Income Countries

IntroductionThere is substantial evidence that maternal health services across the continuum of care are effective in reducing morbidities and mortalities associated with pregnancy and childbirth. There is also consensus regarding the need to invest in the delivery of these services towards the global goal of achieving Universal Health Coverage in low/middle-income countries (LMICs). However, there is limited evidence on the costs of providing these services. This protocol describes the methods and analytical framework to be used in conducting a systematic review of costs of providing maternal health services in LMICs.MethodsAfrican Journal Online, CINAHL Plus, EconLit, Embase, Global Health Archive, Popline, PubMed and Scopus as well as grey literature databases will be searched for relevant articles which report primary cost data for maternal health service in LMICs published from January 2000 to June 2019. This search will be conducted without implementing any language restrictions. Two reviewers will independently search, screen and select articles that meet the inclusion criteria, with disagreements resolved by discussions with a third reviewer. Quality assessment of included articles will be conducted based on cost-focused criteria included in globally recommended checklists for economic evaluations. For comparability, where feasible, cost will be converted to international dollar equivalents using purchasing power parity conversion factors. Costs associated with providing each maternal health services will be systematically compared, using a subgroup analysis. Sensitivity analysis will also be conducted. Where heterogeneity is observed, a narrative synthesis will be used. Population contextual and intervention design characteristics that help achieve cost savings and improve efficiency of maternal health service provision in LMICs will be identified.Ethics and disseminationEthical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders.PROSPERO registration numberCRD42018114124

scholarly journals Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review

2017 ◽  
Vol 49 (1-2) ◽  
pp. 45-61 ◽  
Author(s):  
Jeyaraj Durai Pandian ◽  
Akanksha G. William ◽  
Mahesh P. Kate ◽  
Bo Norrving ◽  
George A. Mensah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care Services ◽  
Cost Effective ◽  
Stroke Care ◽  
Evidence Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Services ◽  
Stroke Services ◽  
Low And Middle Income

Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.

scholarly journals Cost and cost-effectiveness analysis of treatment for child undernutrition in low- and middle-income countries: A systematic review

2020 ◽  
Vol 5 ◽  
pp. 62
Author(s):  
Rebecca G Njuguna ◽  
James A Berkley ◽  
Julie Jemutai
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Service Providers ◽  
Productivity Loss ◽  
Sub Saharan Africa ◽  
Economic Evaluations ◽  
Middle Income ◽  
Child Undernutrition ◽  
Middle Income Countries ◽  
Low And Middle Income

Background: Undernutrition remains highly prevalent in low- and middle-income countries, with sub-Saharan Africa and Southern Asia accounting for majority of the cases. Apart from the health and human capacity impacts on children affected by malnutrition, there are significant economic impacts to households and service providers. The aim of this study was to determine the current state of knowledge on costs and cost-effectiveness of child undernutrition treatment to households, health providers, organizations and governments in low and middle-income countries (LMICs). Methods:  We conducted a systematic review of peer-reviewed studies in LMICs up to September 2019. We searched online databases including PubMed-Medline, Embase, Popline, Econlit and Web of Science. We identified additional articles through bibliographic citation searches. Only articles including costs of child undernutrition treatment were included. Results: We identified a total of 6436 articles, and only 50 met the eligibility criteria. Most included studies adopted institutional/program (45%) and health provider (38%) perspectives. The studies varied in the interventions studied and costing methods used with treatment costs reported ranging between US$0.44 and US$1344 per child. The main cost drivers were personnel, therapeutic food and productivity loss. We also assessed the cost effectiveness of community-based management of malnutrition programs (CMAM). Cost per disability adjusted life year (DALY) averted for a CMAM program integrated into existing health services in Malawi was $42. Overall, cost per DALY averted for CMAM ranged between US$26 and US$53, which was much lower than facility-based management (US$1344). Conclusion: There is a need to assess the burden of direct and indirect costs of child undernutrition to households and communities in order to plan, identify cost-effective solutions and address issues of cost that may limit delivery, uptake and effectiveness. Standardized methods and reporting in economic evaluations would facilitate interpretation and provide a means for comparing costs and cost-effectiveness of interventions.

scholarly journals Examining the use of economic evaluations in health-related humanitarian programmes in low- and middle-income countries: a systematic review

2019 ◽  
Vol 35 (2) ◽  
pp. 210-218 ◽  
Author(s):  
Lizna A Makhani ◽  
Valerie Moran ◽  
Zia Sadique ◽  
Neha S Singh ◽  
Paul Revill ◽  
...  
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Bibliographic Databases ◽  
Economic Evaluations ◽  
Middle Income ◽  
System Perspective ◽  
Middle Income Countries ◽  
Humanitarian Crises ◽  
Health Related ◽  
Low And Middle Income

Abstract The costly nature of health sector responses to humanitarian crises and resource constraints means that there is a need to identify methods for priority setting and long-term planning. One method is economic evaluation. The aim of this systematic review is to examine the use of economic evaluations in health-related humanitarian programmes in low- and middle-income countries. This review used peer-reviewed literature published between January 1980 and June 2018 extracted from four main electronic bibliographic databases. The eligibility criteria were full economic evaluations (which compare the costs and outcomes of at least two interventions and provide information on efficiency) of health-related services in humanitarian crises in low- and middle-countries. The quality of eligible studies is appraised using the modified 36-question Drummond checklist. From a total of 8127 total studies, 11 full economic evaluations were identified. All economic evaluations were cost-effectiveness analyses. Three of the 11 studies used a provider perspective, 2 studies used a healthcare system perspective, 3 studies used a societal perspective and 3 studies did not specify the perspective used. The lower quality studies failed to provide 7information on the unit of costs and did not justify the time horizon of costs and discount rates, or conduct a sensitivity analysis. There was limited geographic range of the studies, with 9 of the 11 studies conducted in Africa. Recommendations include greater use of economic evaluation methods and data to enhance the microeconomic understanding of health interventions in humanitarian settings to support greater efficiency and transparency and to strengthen capacity by recruiting economists and providing training in economic methods to humanitarian agencies.

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