Cost-effectiveness of different strategies for tuberculosis control programs in Thailand

Hunchangsith, P., Barendregt, J. J., Vos, T. and Bertram, M. (2010). Cost-effectiveness of different strategies for tuberculosis control programs in Thailand. In: ISPOR 4th Asia-Pacific Conference Research Abstracts. ISPOR 4th Asia-Pacific Conference, Phuket, Thailand, (A504-A505). 5-7 September 2010. doi:10.1111/j.1524-4733.2010.00793_3.x

Author Hunchangsith, P.
Barendregt, J. J.
Vos, T.
Bertram, M.
Title of paper Cost-effectiveness of different strategies for tuberculosis control programs in Thailand
Conference name ISPOR 4th Asia-Pacific Conference
Conference location Phuket, Thailand
Conference dates 5-7 September 2010
Proceedings title ISPOR 4th Asia-Pacific Conference Research Abstracts   Check publisher's open access policy
Journal name Value in Health   Check publisher's open access policy
Place of Publication Hoboken, NJ, U.S.A.
Publication Year 2010
Sub-type Published abstract
DOI 10.1111/j.1524-4733.2010.00793_3.x
ISSN 1098-3015
Volume 13
Issue 7
Start page A504
End page A505
Total pages 2
Language eng
Formatted Abstract/Summary
Objectives: To evaluate the cost-effectiveness of different strategies to control tuberculosis (TB) in Thailand.

Strategies included directly observed treatment (DOT) by a health worker, community member, or family member, and a mobile phone “contact-reminder” system, compared to self-administered treatment (SAT). Cost-effectiveness analysis was undertaken using a decision tree model, which had three stages of treatment; initial treatment, re-treatment, and multi-drug resistant TB (MDR-TB) treatment. Costs (2005 international dollars: I$) were calculated based on treatment periods and treatment outcomes. Health outcomes were estimated over the lifetime of smear-positive pulmonary TB patients in disability-adjusted life-years (DALYs). Both costs and health outcomes were discounted at 3%.

Results: Cost effectiveness results did not clearly indicate a preference for any of the interventions analyzed. Although the median cost-effectiveness ratio for each DOT intervention was favorable, 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 in DALY for family-member DOT was 9400 DALY (95% uncertainty interval −7200 to 25,000), for community-member DOT was 13,000 (−21,000 to 37,000) and health-worker DOT was 7900 (−50,000 to 43,000). There were cost savings (from less re-treatment or MDR-TB treatment) associated with family-member DOT (–I$9 million (–I$12 million to –I$5 million)) as the trial treatment failure rate was significantly lower than for SAT. The mobile phone reminder system was not cost-effective, as the mortality rate in the small trial of this intervention was much higher than for each of the other treatment strategies but this was likely to have been due to the selection of an elderly population in this trial rather than a result of the intervention.

Conclusions: The large uncertainty around the potential benefits of DOT strategies prohibits a conclusive statement regarding their cost-effectiveness in comparison to SAT.

Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Conference Paper
Collection: School of Public Health Publications
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Created: Sun, 09 Jan 2011, 10:00:15 EST