Cost-effectiveness Analysis of Multi Drug Resistant Tuberculosis at Treatment Initiative and Follow up Centers in Addis Ababa, Ethiopia

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Addis Ababa Universty


Background: Ethiopia is among 30 high burden TB, TB/HIV and MDR-TB country which account 80% all new TB case worldwide [55].According to2014 national drug resistant TB report the prevalence of MDR-TB was 2.3% and 17.8% among new and perversely TB treated case respectively. The data indicate that MDR-TB has been becoming a significant public health threat in the country. Significance of the study is to avoid the financial risk results from illness-related expenditures and identify the most cost effective intervention. Objective: To analyze the cost-effectiveness of MDR-TB treatment in hospitals (treatment initiative center) and health centers (treatment follow up center). Methods: Full economic evaluation using markov model to provide relevant cost and effectiveness information. The study was in St. Peter specialized and ALERT Hospitals as treatment Initiated centers (TIC) and health centers or treatment follow up centers (TFC). A total sample of two hundred fifty five MDR-TB patients with age greater than 15, selected by using simple random sampling. The data are collected from the hospitals record and patients’ interview after having an informed consent. Markov model, is created using TreeAge Pro Suite 2018 to analyze and estimate cost-effectiveness of the MDRTB treatment at treatment Initiation and follow up centers (TIC and TFC). The Model also structured in five health states. The costs and effectiveness discounted for the base case at an annual rate of 3% at the time of study. The Probability and costs have one year cycle length and life time horizon. Data are checked for its completeness cleaned and analyzed with Markov model developed using TreeAge Software to estimate the Cost-effectiveness of the MDR-TB treatment. Effects are measured as Treatment Success Rate (TSR), treatment failure, death and disability-adjusted life-years (DALYs) averted. Costs are assessed societal perspective in the two major areas, patients and service providers. The escorts/care givers are excluded from the study due to non-reliability of data that could be found for the analysis. Results: The cost of MDR-TB treatment for HIV negative patients per TSR USD 8416.17 for TIC and USD 6,657.15 for TFC the Cost-effectiveness analysis depicted that both treatment centers (TIC and TFC) are cost effective in treating MDR-TB at the incremental cost-effectiveness ratio (ICER) of $1641 per DALYs averted. However, the study revealed that TFC (health center) is decidedly cost effective for the treatment of Tuberculosis’s at the TSR of 88% to 94% if WTP threshold is define one GDP per capital per DALY averted in Ethiopia. Conclusion: The study also provides evidence that the costs of MDR-TB treatment is high specially at TIC than at TFC, however based on the results of the study analysis for MDR-TB treatment both are Cost-effectiveness option at less than 3 times GPD per capital per DALYs averted in Ethiopia and compares the treatment at initiation and follows up centers (TIC and TFC) centers TFC was less cost. .



Cost, effectiveness, Cost-effectiveness, MDR-TB Treatment, Treatment Centers