Cost-effectiveness of various tuberculosis control strategies in Thailand

Hunchangsith, Pojjana, Barendregt, Jan J., Vos, Theo and Bertram, Melanie (2012) Cost-effectiveness of various tuberculosis control strategies in Thailand. Value in Health, 15 1 Supp.: S50-S55. doi:10.1016/j.jval.2011.11.006

Author Hunchangsith, Pojjana
Barendregt, Jan J.
Vos, Theo
Bertram, Melanie
Title Cost-effectiveness of various tuberculosis control strategies in Thailand
Journal name Value in Health   Check publisher's open access policy
ISSN 1098-3015
Publication date 2012-01
Sub-type Article (original research)
DOI 10.1016/j.jval.2011.11.006
Volume 15
Issue 1 Supp.
Start page S50
End page S55
Total pages 6
Place of publication New York, NY, U.S.A.
Publisher Elsevier
Collection year 2013
Language eng
Formatted abstract
Objective: To evaluate the cost-effectiveness of different tuberculosis control strategies in Thailand.

Methods: Different tuberculosis control strategies, which included health-worker, community-member, and family-member directly observed treatment (DOT) and a mobile phone “contact-reminder” system, were compared with self-administered treatment (SAT). Cost-effectiveness analysis was undertaken by using a decision tree model. Costs (2005 international dollars [I$]) were calculated on the basis of treatment periods and treatment outcomes. Health outcomes were estimated over the lifetime of smear-positive pulmonary tuberculosis patients in disability-adjusted life years (DALYs) averted on the basis of Thai evidence on the efficacy of the selected strategies.

Results: Cost-effectiveness results indicate no preference for any strategy. The uncertainty ranges surrounding the health benefits were wide, including a sizeable probability that SAT could lead to more health gain than DOT strategies. The health gain for family-member DOT was 9400 DALYs (95% uncertainty interval −7200 to 25,000), for community-member DOT was 13,000 DALYs (95% uncertainty interval −21,000 to 37,000), and for health-worker DOT was 7900 DALYs (95% uncertainty interval −50,000 to 43,000). There were cost savings (from less multi-drug resistant tuberculosis treatment) associated with family-member DOT (−I$9 million [95% uncertainty interval −I$12 million to −I$5 million]) because the trial treatment failure rate was significantly lower than that for SAT. The mobile phone reminder system was not cost-effective, because the mortality rate associated with it was much higher than that associated with other treatment strategies.

Conclusions: Because of the large uncertainty intervals around health gain for DOT strategies, it remains inconclusive whether DOT strategies are more cost-effective than SAT. It is evident, however, that family-member DOT is a cost-saving intervention.
Keyword Cost-effectiveness
Mobile phone reminder
Self-administered treatment
Randomized controlled-trial
Directly observed therapy
Observed treatment dot
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Special Issue: "3rd Special Issue: Pharmacoeconomics and Outcomes Research in Asia".

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
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