1
|
Holmes M, Mukora R, Mudzengi D, Charalambous S, Chetty-Makkan CM, Kisbey-Green H, Maraisane M, Grund J. An economic evaluation of an intervention to increase demand for medical male circumcision among men aged 25-49 years in South Africa. BMC Health Serv Res 2021; 21:1097. [PMID: 34654429 PMCID: PMC8520207 DOI: 10.1186/s12913-021-06793-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies estimate that circumcising men between the ages of 20-30 years who have exhibited previous risky sexual behaviour could reduce overall HIV prevalence. Demand creation strategies for medical male circumcision (MMC) targeting men in this age group may significantly impact these prevalence rates. OBJECTIVES The objective of this study is to evaluate the cost-effectiveness and cost-benefit of an implementation science, pre-post study designed to increase the uptake of male circumcision for ages 25-49 at a fixed MMC clinic located in Gauteng Province, South Africa. METHODS A health care provider perspective was utilised to collect all costs. Costs were compared between the standard care scenario of routine outreach strategies and a full intervention strategy. Cost-effectiveness was measured as cost per mature man enrolled and cost per mature man circumcised. A cost-benefit analysis was employed by using the Bernoulli model to estimate the cases of HIV averted due to medical male circumcision (MMC), and subsequently translated to averted medical costs. RESULTS In the 2015 intervention, the cost of the intervention was $9445 for 722 men. The total HIV treatment costs averted due to the intervention were $542,491 from a public care model and $378,073 from a private care model. The benefit-cost ratio was 57.44 for the public care model and 40.03 for the private care model. The net savings of the intervention were $533,046 or $368,628 - depending on treatment in a public or private setting. CONCLUSIONS The intervention was cost-effective compared to similar MMC demand interventions and led to statistically significant cost savings per individual enrolled.
Collapse
Affiliation(s)
- M Holmes
- Centers for Disease Control and Prevention, Atlanta, GA, USA. .,Economics Department, Spelman College, 350 Spelman Lane, Atlanta, GA, 30314, USA.
| | - R Mukora
- The Aurum Institute, Johannesburg, South Africa
| | - D Mudzengi
- The Aurum Institute, Johannesburg, South Africa
| | - S Charalambous
- The Aurum Institute, Johannesburg, South Africa.,The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - C M Chetty-Makkan
- The Aurum Institute, Johannesburg, South Africa.,The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Epidemiology Research Office, Johannesburg, South Africa
| | | | - M Maraisane
- The Aurum Institute, Johannesburg, South Africa
| | - J Grund
- Centers for Disease Control and Prevention, Atlanta, GA, USA.,Centers for Disease Control and Prevention, Pretoria, South Africa
| |
Collapse
|
2
|
Sohn H, Sweeney S, Mudzengi D, Creswell J, Menzies NA, Fox GJ, MacPherson P, Dowdy DW. Determining the value of TB active case-finding: current evidence and methodological considerations. Int J Tuberc Lung Dis 2021; 25:171-181. [PMID: 33688805 PMCID: PMC8647907 DOI: 10.5588/ijtld.20.0565] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Active case-finding (ACF) is an important component of the End TB Strategy. However, ACF is resource-intensive, and the economics of ACF are not well-understood. Data on the costs of ACF are limited, with little consistency in the units and methods used to estimate and report costs. Mathematical models to forecast the long-term effects of ACF require empirical measurements of the yield, timing and costs of case detection. Pragmatic trials offer an opportunity to assess the cost-effectiveness of ACF interventions within a 'real-world´ context. However, such analyses generally require early introduction of economic evaluations to enable prospective data collection on resource requirements. Closing the global case-detection gap will require substantial additional resources, including continued investment in innovative technologies. Research is essential to the optimal implementation, cost-effectiveness, and affordability of ACF in high-burden settings. To assess the value of ACF, we must prioritize the collection of high-quality data regarding costs and effectiveness, and link those data to analytical models that are adapted to local settings.
Collapse
Affiliation(s)
- H Sohn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S Sweeney
- London School of Hygiene & Tropical Medicine, London, UK
| | - D Mudzengi
- The Aurum Institute, Johannesburg, South Africa
| | - J Creswell
- The Stop TB Partnership, UNOPS, Geneva, Switzerland
| | - N A Menzies
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - G J Fox
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - P MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Malawi, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
3
|
White RG, Charalambous S, Cardenas V, Hippner P, Sumner T, Bozzani F, Mudzengi D, Houben RMGJ, Collier D, Kimerling ME, Vassall A, Pillay Y, Churchyard G. Evidence-informed policy making at country level: lessons learned from the South African Tuberculosis Think Tank. Int J Tuberc Lung Dis 2019; 22:606-613. [PMID: 29862943 PMCID: PMC5947421 DOI: 10.5588/ijtld.17.0485] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: National Tuberculosis Programmes (NTPs) require specialist input to support the development of policy and practice informed by evidence, typically against tight deadlines. OBJECTIVE: To describe lessons learned from establishing a dedicated tuberculosis (TB) think tank to advise the South African NTP on TB policy. INTERVENTION AND EVALUATION METHODS: A national TB think tank was established to advise the NTP in support of evidence-informed policy. Support was provided for activities, including meetings, modelling and regular telephone calls, with a wider network of unpaid expert advisers under an executive committee and working groups. Intervention evaluation used desktop analysis of documentary evidence, interviews and direct observation. RESULTS: The TB Think Tank evolved over time to acquire three key roles: an ‘institution’, a ‘policy dialogue forum’ and an ‘interface’. Although enthusiasm was high, motivating participation among the NTP and external experts proved challenging. Motivation of working groups was most successful when aligned to a specific need for NTP decision making. Despite challenges, the TB Think Tank contributed to South Africa's first ever TB and human immunodeficiency virus (HIV) investment case, and the decision to create South Africa's first ever ring-fenced grant for TB. The TB Think Tank also assisted the NTP in formulating strategy to accelerate progress towards reaching World Health Organization targets. DISCUSSION: With partners, the TB Think Tank achieved major successes in supporting evidence-informed decision making, and garnered increased funding for TB in South Africa. Identifying ways to increase the involvement of NTP staff and other experts, and keeping the scope of the Think Tank well defined, could facilitate greater impact. Think tank initiatives could be replicated in other settings to support evidence-informed policy making.
Collapse
Affiliation(s)
- R G White
- TB Modelling Group, Centre for the Mathematical Modelling of Infectious Diseases, and Department of Infectious Disease Epidemiology, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - S Charalambous
- Aurum Institute, Johannesburg, School of Public Health, University of Witwatersrand, Johannesburg, Advancing Treatment and Care for TB/HIV, South African Medical Research Council, Johannesburg, South Africa
| | | | | | - T Sumner
- TB Modelling Group, Centre for the Mathematical Modelling of Infectious Diseases, and Department of Infectious Disease Epidemiology
| | - F Bozzani
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - R M G J Houben
- TB Modelling Group, Centre for the Mathematical Modelling of Infectious Diseases, and Department of Infectious Disease Epidemiology, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - M E Kimerling
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - A Vassall
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Y Pillay
- South African National TB Control Programme, Pretoria, South Africa
| | - G Churchyard
- TB Modelling Group, Centre for the Mathematical Modelling of Infectious Diseases, and Department of Infectious Disease Epidemiology, Aurum Institute, Johannesburg, School of Public Health, University of Witwatersrand, Johannesburg, Advancing Treatment and Care for TB/HIV, South African Medical Research Council, Johannesburg, South Africa
| |
Collapse
|