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Cost-effectiveness of treating multidrug-resistant tuberculosis in treatment initiative centers and treatment follow-up centers in Ethiopia

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  • Senait Alemayehu
  • Amanuel Yigezu
  • Damen Hailemariam
  • Alemayehu Hailu

Abstract

Background: In Ethiopia, MDR-TB has become a significant public health threat; therefore, the Ministry of Health introduced two treatment approaches for MDR-TB cases: treatment initiative center (TIC) and treatment follow-up center (TFC). TIC is where patients usually are diagnosed and start the treatment. At TFC, we follow MDR-TB patients until they completed the treatment. However, there is no evidence about the cost-effectiveness of the approaches. Therefore, this study aimed to analyze the cost-effectiveness of MDR-TB treatment in TIC and TFC. Methods: In this study, we employed a full economic evaluation from a providers' perspective. We followed a hypothetical cohort of individuals from the age of 15 for a lifetime using a Markov model with five mutually exclusive health states. We used both primary and secondary data sources for the study. Ingredient-based costing approach was used. The costs include healthcare provider costs (recurrent and capital cost) and patient-side costs (direct and indirect). We use a human capital approach to estimate the indirect cost. The cost estimates were reported in the 2017 United States Dollar (US$), and effectiveness was measured using disability-adjusted life-years (DALYs) averted. Both costs and health benefits were discounted using a 3% discount rate. Both average and incremental cost-effectiveness ratios (ICER) were reported calculated. One-way and probabilistic sensitivity analyses were reported to determine the robustness of the estimates. Results: The cost per HIV negative patient successfully treated for MDR-TB was $8,416 at TIC and $6,657 at TFC. The average cost-effectiveness ratio per DALY averted at TFC was $671 and $1,417 per DALY averted at TIC. The incremental cost-effectiveness ratio (ICER) of MDR-TB treatment at TIC was $1,641 per DALYs averted. Conclusion: This study indicates that the treatment of MDR-TB at both TIC and TFC are cost-effective interventions compared with the willingness to pay threshold of three-times the GDP per capita in Ethiopia.

Suggested Citation

  • Senait Alemayehu & Amanuel Yigezu & Damen Hailemariam & Alemayehu Hailu, 2020. "Cost-effectiveness of treating multidrug-resistant tuberculosis in treatment initiative centers and treatment follow-up centers in Ethiopia," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-13, July.
    • Handle: RePEc:plo:pone00:0235820
    DOI: 10.1371/journal.pone.0235820
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    References listed on IDEAS

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    1. C. Fitzpatrick & K. Floyd, 2012. "Erratum to Systematic Reviewof the Cost and Cost Effectiveness of Treatment for Multidrug-Resistant Tuberculosis," PharmacoEconomics, Springer, vol. 30(1), pages 81-81, January.
    2. Christopher Fitzpatrick & Katherine Floyd, 2012. "A Systematic Review of the Cost and Cost Effectiveness of Treatment for Multidrug-Resistant Tuberculosis," PharmacoEconomics, Springer, vol. 30(1), pages 63-80, January.
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    1. Stephanie Bogdewic & Rohit Ramaswamy & David M Goodman & Emmanuel K Srofenyoh & Sebnem Ucer & Medge D Owen, 2020. "The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-18, November.

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