Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models.
Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models.
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DOI：
10.1016/s2214-109x(16)30265-0
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发表时间：
2016-11
期刊：
影响因子：
--
通讯作者：
Vassall A
中科院分区：
文献类型：
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作者：
Menzies NA;Gomez GB;Bozzani F;Chatterjee S;Foster N;Baena IG;Laurence YV;Qiang S;Siroka A;Sweeney S;Verguet S;Arinaminpathy N;Azman AS;Bendavid E;Chang ST;Cohen T;Denholm JT;Dowdy DW;Eckhoff PA;Goldhaber-Fiebert JD;Handel A;Huynh GH;Lalli M;Lin HH;Mandal S;McBryde ES;Pandey S;Salomon JA;Suen SC;Sumner T;Trauer JM;Wagner BG;Whalen CC;Wu CY;Boccia D;Chadha VK;Charalambous S;Chin DP;Churchyard G;Daniels C;Dewan P;Ditiu L;Eaton JW;Grant AD;Hippner P;Hosseini M;Mametja D;Pretorius C;Pillay Y;Rade K;Sahu S;Wang L;Houben RMGJ;Kimerling ME;White RG;Vassall A
《终结结核病战略》设定了到2025年将结核病发病率和死亡率分别降低50%和75%的全球目标。我们评估了在中国、印度和南非实现这些目标的资源需求和战略的成本效益。我们研究了与国家利益相关者协商制定的干预方案，这些方案将现有干预措施扩大到2025年的高覆盖率，但可行。九个独立的结核病建模小组合作评估政策成果，我们通过综合服务利用估计、经验成本数据和专家对实施战略的意见来计算每种情况的成本。我们估计了2016-2035年的健康影响和资源影响，包括患者产生的费用。为了评估资源需求和成本效益，我们将情景与代表持续当前实践的基本案例进行了比较。结核病服务费用的增加因情况和国家而异，在某些情况下，增加的费用是目前资金需求的两倍以上。总体而言，扩大结核病服务大大降低了患者产生的费用;在印度和中国，从社会角度来看，这为大多数干预措施带来了净成本节约。在所有国家，扩大结核病护理的可及性产生了巨大的健康收益。与目前的做法相比，与传统的成本效益阈值相比，大多数干预办法似乎具有很高的成本效益。扩大结核病服务似乎对高负担国家具有成本效益，并可能为患者带来巨大的健康和经济利益，尽管资金需求挑战负担能力。需要进一步开展工作，以确定每个国家的最佳干预组合。
The End TB Strategy sets global goals of reducing TB incidence and mortality by 50% and 75% respectively by 2025. We assessed resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. We examined intervention scenarios developed in consultation with country stakeholders, which scaled-up existing interventions to high but feasible coverage by 2025. Nine independent TB modelling groups collaborated to estimate policy outcomes, and we costed each scenario by synthesizing service utilization estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health impact and resource implications for 2016–2035, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios to a base case representing continued current practice. Incremental TB service costs differed by scenario and country, and in some cases more than doubled current funding needs. In general, expanding TB services substantially reduced patient-incurred costs; and in India and China this produced net cost-savings for most interventions under a societal perspective. In all countries, expanding TB care access produced substantial health gains. Compared to current practice, most intervention approaches appeared highly cost-effective when compared to conventional cost-effectiveness thresholds. Expanding TB services appears cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, though funding needs challenge affordability. Further work is required to determine the optimal intervention mix for each country.