Cost-effectiveness Analysis of Multi Drug Resistant Tuberculosis at Treatment Initiative and Follow up Centers in Addis Ababa, Ethiopia
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Date
2018-10
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Addis Ababa Universty
Abstract
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. .
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Keywords
Cost, effectiveness, Cost-effectiveness, MDR-TB Treatment, Treatment Centers