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Sweeney S, Laurence YV, Cunnama L, Gomez GB, Garcia-Baena I, Bhide P, Capeding TJ, Chatterjee S, Chikovani I, Eyob H, Kairu A, Terefe MM, Shengelia N, Toshniwal M, Saadi N, Bergren E, Vassall A. Cost of TB services: approach and summary findings of a multi-country study (Value TB). Int J Tuberc Lung Dis 2022; 26:1006-1015. [PMID: 36281042 PMCID: PMC9621303 DOI: 10.5588/ijtld.22.0096] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: There are currently large gaps in unit cost data for TB, and substantial variation in the quality and methods of unit cost estimates. Uncertainties remain about sample size, range and comprehensiveness of cost data collection for different purposes. We present the methods and results of a project implemented in Kenya, Ethiopia, India, The Philippines and Georgia to estimate unit costs of TB services, focusing on findings most relevant to these remaining methodological challenges.METHODS: We estimated financial and economic unit costs, in close collaboration with national TB programmes. Gold standard methods included both top-down and bottom-up approaches to resource use measurement. Costs are presented in 2018 USD and local currency unit.RESULTS: Cost drivers of outputs varied by service and across countries, as did levels of capacity inefficiency. There was substantial variation in unit cost estimates for some interventions and high overhead costs were observed. Estimates were subject to sampling uncertainty, and some data gaps remain.CONCLUSION: This paper describes detailed methods for the largest TB costing effort to date, to inform prioritisation and planning for TB services. This study provides a strong baseline and some cost estimates may be extrapolated from this data; however, regular further studies of similar quality are needed to add estimates for remaining gaps, or to add new or changing services and interventions. Further research is needed on the best approach to extrapolation of cost data. Costing studies are best implemented as partnerships with policy makers to generate a community of mutual learning and capacity development.
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Affiliation(s)
- S Sweeney
- Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Y V Laurence
- Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - L Cunnama
- University of Cape Town, Cape Town, South Africa
| | - G B Gomez
- Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, UK, Global Access, International Aids Vaccine Initiative, Amsterdam, The Netherlands
| | | | - P Bhide
- The George Institute for Global Health, New Delhi, India
| | - T J Capeding
- University of the Philippines Manila, Manila, The Philippines
| | - S Chatterjee
- The George Institute for Global Health, New Delhi, India
| | - I Chikovani
- Curatio International Foundation, Tbilisi, Georgia
| | - H Eyob
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - A Kairu
- Health Economics Research Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - M M Terefe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - N Shengelia
- Curatio International Foundation, Tbilisi, Georgia
| | | | - N Saadi
- Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, UK, University of Oslo, Oslo, Norway
| | - E Bergren
- Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - A Vassall
- Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, UK
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Capeding TPJ, Rosa JD, Lam H, Gaviola DG, Garfin AMC, Hontiveros C, Cunnama L, Laurence YV, Kitson N, Vassall A, Sweeney S, Garcia-Baena I. Cost of TB prevention and treatment in the Philippines in 2017. Int J Tuberc Lung Dis 2022; 26:392-398. [PMID: 35505478 PMCID: PMC9067429 DOI: 10.5588/ijtld.21.0622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND: The Philippines aims to accelerate TB reduction through the provision of universally accessible and affordable services. The objectives of this paper are to estimate the costs of TB services and interventions using a health systems´ perspective, and to explore cost differences in service delivery via primary care facilities or hospitals.METHODS: Data were collected from a multi-stage stratified random sampling of 28 facilities in accordance with Global Health Cost Consortium costing standards and analysis tools. Unit costs (in US$) estimated using top-down (TD) and bottom-up (BU) approaches, are summarised following Value TB reporting standards and by broad facility type.RESULTS: Cost of delivering 32 TB services and eight interventions varied by costing method and delivery platform. Average BU costs ranged from US$0.38 for treatment support visits, US$2.5 for BCG vaccination, US$19.48 for the Xpert® MTB/RIF test to US$3,677 for MDR-TB treatment using the long regimen. Delivering TB care in hospitals was generally more costly than in primary care facilities, except for TB prevention in children and MDR-TB treatment using the long regimen.CONCLUSION: Comprehensive costing data for TB care in the Philippines are now available to aid in the design, planning, and prioritisation of delivery models to End TB.
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Affiliation(s)
- T. P. J. Capeding
- Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - J. D. Rosa
- Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - H. Lam
- Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - D. G. Gaviola
- Department of Health, National TB Control Programme, Manila, Philippines
| | - A. M. C. Garfin
- Department of Health, National TB Control Programme, Manila, Philippines
| | - C. Hontiveros
- Department of Health, National TB Control Programme, Manila, Philippines
| | - L. Cunnama
- Health Economics Unit & Health Economics Division, University of Cape Town, Cape Town, South Africa
| | - Y. V. Laurence
- Department of Global Health and Development, Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - N. Kitson
- Department of Global Health and Development, Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - A. Vassall
- Department of Global Health and Development, Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - S. Sweeney
- Department of Global Health and Development, Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - I. Garcia-Baena
- Global TB Programme, World Health Organization, Geneva, Switzerland
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