Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods.
Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods.
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DOI：
10.1136/bmjgh-2022-010306
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发表时间：
2023-02
影响因子：
8.1
通讯作者：
Vassall, Anna
中科院分区：
文献类型：
--
作者：
Bozzani, Fiammetta Maria;McCreesh, Nicky;Diaconu, Karin;Govender, Indira;White, Richard G.;Kielmann, Karina;Grant, Alison D.;Vassall, Anna
结核分枝杆菌（Mtb）的院内传播严重影响卫生工作者、患者和社区。结核病感染预防和控制指南（TB IPC）已经存在，但在许多环境中的实施仍然不够理想。需要有证据表明，在常规诊所环境中进行具有成本效益的投资，以预防结核病传播。利用系统动力学建模技术，与当地利益攸关方共同设计了一套结核病IPC干预措施，这些干预措施涉及核心活动和支持实施的扶持行动。在夸祖鲁-纳塔尔的两个诊所对这些干预措施进行了经济评价，采用了诊所内及其集水区人群中结核分枝杆菌传播的代理模型。干预成本包括利益攸关方确定的使能因素（如加强监督、社区宣传）的成本，以确保吸收和遵守。所有模拟的干预方案，包括相关的使能因素，每避免一个残疾调整生命年的成本不到200美元，与南非基于机会成本的阈值（每避免一个残疾调整生命年3 200美元）相比，具有很高的成本效益。两项干预措施，建筑改造，以改善通风和最大限度地利用现有的中央慢性药物分配和分配系统，以减少诊所就诊人数，被认为是节省成本超过10年的模型时间范围。增量成本效益比对基线诊所通气率、诊所就诊者中传染性结核病患病率和未来艾滋病毒发病率的假设敏感，但在所有不确定性分析情景下仍具有高度成本效益。诊所的结核病IPC干预措施，包括确保其可行性的扶持行动，提供了非常好的资金价值，应优先在南非卫生系统内实施。
Nosocomial Mycobacterium tuberculosis (Mtb) transmission substantially impacts health workers, patients and communities. Guidelines for tuberculosis infection prevention and control (TB IPC) exist but implementation in many settings remains suboptimal. Evidence is needed on cost-effective investments to prevent Mtb transmission that are feasible in routine clinic environments. A set of TB IPC interventions was codesigned with local stakeholders using system dynamics modelling techniques that addressed both core activities and enabling actions to support implementation. An economic evaluation of these interventions was conducted at two clinics in KwaZulu-Natal, employing agent-based models of Mtb transmission within the clinics and in their catchment populations. Intervention costs included the costs of the enablers (eg, strengthened supervision, community sensitisation) identified by stakeholders to ensure uptake and adherence. All intervention scenarios modelled, inclusive of the relevant enablers, cost less than US$200 per disability-adjusted life-year (DALY) averted and were very cost-effective in comparison to South Africa’s opportunity cost-based threshold (US$3200 per DALY averted). Two interventions, building modifications to improve ventilation and maximising use of the existing Central Chronic Medicines Dispensing and Distribution system to reduce the number of clinic attendees, were found to be cost saving over the 10-year model time horizon. Incremental cost-effectiveness ratios were sensitive to assumptions on baseline clinic ventilation rates, the prevalence of infectious TB in clinic attendees and future HIV incidence but remained highly cost-effective under all uncertainty analysis scenarios. TB IPC interventions in clinics, including the enabling actions to ensure their feasibility, afford very good value for money and should be prioritised for implementation within the South African health system.
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影响因子：
8.1
作者：
Kielmann, Karina;Karat, Aaron S.;Grant, Alison D.
通讯作者：
Grant, Alison D.
DOI：
10.1016/j.jval.2020.05.021
发表时间：
2020-11
期刊：
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
影响因子：
--
作者：
Bozzani FM;Sumner T;Mudzengi D;Gomez GB;White R;Vassall A
通讯作者：
Vassall A
影响因子：
8.1
作者：
McCreesh N;Karat AS;Baisley K;Diaconu K;Bozzani F;Govender I;Beckwith P;Yates TA;Deol AK;Houben RMGJ;Kielmann K;White RG;Grant AD
通讯作者：
Grant AD
影响因子：
3.2
作者：
Edoka, Ijeoma P.;Stacey, Nicholas K.
通讯作者：
Stacey, Nicholas K.
DOI：
10.5588/ijtld.19.0410
发表时间：
2020-04-01
影响因子：
4
作者：
McCreesh, N.;Grant, A. D.;White, R. G.
通讯作者：
White, R. G.