Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence
Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence
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DOI：
10.1186/1471-2458-5-130
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发表时间：
2005-12-12
影响因子：
4.5
通讯作者：
Dye, C
中科院分区：
文献类型：
--
作者：
Currie, CSM;Floyd, K;Dye, C
背景：艾滋病毒流行已导致东非和南部非洲结核病(TB)病例急剧增加。有几项战略有可能减轻艾滋病毒高流行环境中的结核病负担，成本和成本效益分析有助于在存在预算限制的情况下确定优先顺序。然而，已发表的成本和成本效益研究是有限的。方法：我们的目标是比较在艾滋病毒高流行国家减轻结核病负担的七种战略的成本、可负担性和成本效益。利用结核病和艾滋病毒的分室差分方程式模型和最近的成本数据，评估了肯尼亚2004-2023年期间这些战略的成本(2003年美元价格)和效果(避免结核病病例、避免死亡、获得DALYs)。结果：成本最低、效果最好的3种策略是提高结核病治愈率、提高肺结核病例发现率、两者共同提高。病例发现和治疗的综合改进每年增加的成本不到1500万美元(占2000年政府卫生支出的7.5%)；这三种策略获得的平均DALY成本从18美元到34美元不等。抗逆转录病毒疗法(ART)的增量成本最高，到2007年可能达到2000年政府卫生总支出的水平。与其他策略相比，ART还可以获得更多的DALY，每个DALY获得的成本约为260至530美元。艾滋病毒感染者的潜在结核病感染(TLTI)的治疗费用和效果都很低；每个DALY获得的费用从大约85美元到370美元不等。以低于250美元的成本避免一次艾滋病毒感染将与将结核病病例发现率和治愈率提高到世卫组织目标水平一样具有成本效益。结论：为了减轻艾滋病毒高流行环境中结核病的负担，近期目标应该是提高结核病病例发现率，并尽可能提高结核病治愈率，最好是联合使用。实现抗逆转录病毒治疗的全部潜力将需要大量新的资金和加强卫生系统的能力，以使增加的资金能够得到有效利用。
Background: The HIV epidemic has caused a dramatic increase in tuberculosis ( TB) in East and southern Africa. Several strategies have the potential to reduce the burden of TB in high HIV prevalence settings, and cost and cost-effectiveness analyses can help to prioritize them when budget constraints exist. However, published cost and cost-effectiveness studies are limited. Methods: Our objective was to compare the cost, affordability and cost-effectiveness of seven strategies for reducing the burden of TB in countries with high HIV prevalence. A compartmental difference equation model of TB and HIV and recent cost data were used to assess the costs (year 2003 US$ prices) and effects (TB cases averted, deaths averted, DALYs gained) of these strategies in Kenya during the period 2004-2023. Results: The three lowest cost and most cost-effective strategies were improving TB cure rates, improving TB case detection rates, and improving both together. The incremental cost of combined improvements to case detection and cure was below US$15 million per year (7.5% of year 2000 government health expenditure); the mean cost per DALY gained of these three strategies ranged from US$18 to US$34. Antiretroviral therapy (ART) had the highest incremental costs, which by 2007 could be as large as total government health expenditures in year 2000. ART could also gain more DALYs than the other strategies, at a cost per DALY gained of around US$260 to US$530. Both the costs and effects of treatment for latent tuberculosis infection (TLTI) for HIV+ individuals were low; the cost per DALY gained ranged from about US$85 to US$370. Averting one HIV infection for less than US$250 would be as cost-effective as improving TB case detection and cure rates to WHO target levels. Conclusion: To reduce the burden of TB in high HIV prevalence settings, the immediate goal should be to increase TB case detection rates and, to the extent possible, improve TB cure rates, preferably in combination. Realising the full potential of ART will require substantial new funding and strengthening of health system capacity so that increased funding can be used effectively.