Open AccessCost of tuberculosis treatment in low- and middle-income countries: systematic review and meta-regression
Author(s) -
Mariana Siapka,
Anna Vassall,
Lucy Cunnama,
Carol Pineda,
D Cerecero,
Sedona Sweeney,
Sergio BautistaArredondo,
L Bollinger,
Drew Cameron,
Carol Levin,
Gabriela B. Gomez
Publication year - 2020
Publication title -
the international journal of tuberculosis and lung disease/the international journal of tuberculosis and lung disease. articles traduits en français ...
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.103
H-Index - 110
eISSN - 1815-7920
pISSN - 1027-3719
DOI - 10.5588/ijtld.19.0694
Subject(s) - medicine , per capita , gross domestic product , tuberculosis , demography , meta regression , unit cost , environmental health , meta analysis , population , economics , economic growth , pathology , sociology , microeconomics
BACKGROUND: Despite a scarcity of tuberculosis (TB) cost data, a substantial body of evidence has been accumulating for drug-susceptible TB (DS-TB) treatment. In this study, we review unit costs for DS-TB treatment from a provider´s perspective. We also examine factors driving cost variations and extrapolate unit costs across low- and middle-income countries (LMICs). METHODS: We searched published and grey literature for any empirically collected TB cost estimates. We selected a subgroup of estimates looking at DS-TB treatment. We extracted information on activities and inputs included. We standardised costs into an average per person-month, fitted a multi-level regression model and cross-validated country-level predictions. We then extrapolated estimates for facility-based, directly observed DS-TB treatment across countries. RESULTS: We included 95 cost estimates from 28 studies across 17 countries. Costs predictions were sensitive to characteristics such as delivery mode, whether hospitalisation was included, and inputs accounted for, as well as gross domestic product per capita. Extrapolation results are presented with uncertainty intervals (UIs) for LMICs. Predicted median costs per 6 months of treatment were US$315.30 (95% CI US$222.60–US$417.20) for low-income, US$527.10 (95% CI US$395.70–US$743.70) for lower middle-income and US$896.40 (95% CI US$654.00–US$1214.40) for upper middle-income countries. CONCLUSIONS: Our study provides country-level DS-TB treatment cost estimates suitable for priority setting. These estimates, while not standing as a substitute for local high-quality primary data, can inform global, regional and national exercises.