TY - JOUR
T1 - MDR-TB patients in KwaZulu-Natal, South Africa
T2 - Cost-effectiveness of 5 models of care
AU - Loveday, Marian
AU - Wallengren, Kristina
AU - Reddy, Tarylee
AU - Besada, Donela
AU - Brust, James C.M.
AU - Voce, Anna
AU - Desai, Harsha
AU - Ngozo, Jacqueline
AU - Radebe, Zanele
AU - Master, Iqbal
AU - Padayatchi, Nesri
AU - Daviaud, Emmanuelle
N1 - Funding Information:
The work was funded by the South African Medical Research Council (www.mrc.ac. za), Izumi Foundation (http://izumi.org), University Research Co-operation (URC) and a United Way Worldwide grant (grant ID #: 17245) made possible by the Lilly Foundation on behalf of the Lilly MDR TB Partnership (https://www.lilly.com/ who-we-are). JCMB is supported by the National Institute of Allergy and Infectious Diseases (K23AI083088, P30AI051519). The funders had no role in study design, the collection, analysis, or interpretation of data; in report writing; or the decision to submit the paper for publication. All researchers were independent of funders and sponsors. The funders provided support in the form of salaries for authors ML and ED, they did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. HD is employed by Deloitte Consulting. Her contribution to this manuscript was done in her own time and her employee had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of all authors are articulated in the ‘author contributions’ section. We acknowledge the KwaZulu-Natal Department of Health and thank facility level managers, doctors, nurses and data capturers at the study sites for their assistance. We gratefully acknowledge the participants in the study.
Publisher Copyright:
© 2018 Loveday et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2018/4
Y1 - 2018/4
N2 - Background South Africa has a high burden of MDR-TB, and to provide accessible treatment the government has introduced different models of care. We report the most cost-effective model after comparing cost per patient successfully treated across 5 models of care: centralized hospital, district hospitals (2), and community-based care through clinics or mobile injection teams. Methods In an observational study five cohorts were followed prospectively. The cost analysis adopted a provider perspective and economic cost per patient successfully treated was calculated based on country protocols and length of treatment per patient per model of care. Logistic regression was used to calculate propensity score weights, to compare pairs of treatment groups, whilst adjusting for baseline imbalances between groups. Propensity score weighted costs and treatment success rates were used in the ICER analysis. Sensitivity analysis focused on varying treatment success and length of hospitalization within each model. Results In 1,038 MDR-TB patients 75% were HIV-infected and 56% were successfully treated. The cost per successfully treated patient was 3 to 4.5 times lower in the community-based models with no hospitalization. Overall, the Mobile model was the most cost-effective. Conclusion Reducing the length of hospitalization and following community-based models of care improves the affordability of MDR-TB treatment without compromising its effectiveness.
AB - Background South Africa has a high burden of MDR-TB, and to provide accessible treatment the government has introduced different models of care. We report the most cost-effective model after comparing cost per patient successfully treated across 5 models of care: centralized hospital, district hospitals (2), and community-based care through clinics or mobile injection teams. Methods In an observational study five cohorts were followed prospectively. The cost analysis adopted a provider perspective and economic cost per patient successfully treated was calculated based on country protocols and length of treatment per patient per model of care. Logistic regression was used to calculate propensity score weights, to compare pairs of treatment groups, whilst adjusting for baseline imbalances between groups. Propensity score weighted costs and treatment success rates were used in the ICER analysis. Sensitivity analysis focused on varying treatment success and length of hospitalization within each model. Results In 1,038 MDR-TB patients 75% were HIV-infected and 56% were successfully treated. The cost per successfully treated patient was 3 to 4.5 times lower in the community-based models with no hospitalization. Overall, the Mobile model was the most cost-effective. Conclusion Reducing the length of hospitalization and following community-based models of care improves the affordability of MDR-TB treatment without compromising its effectiveness.
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U2 - 10.1371/journal.pone.0196003
DO - 10.1371/journal.pone.0196003
M3 - Article
C2 - 29668748
AN - SCOPUS:85045615748
SN - 1932-6203
VL - 13
JO - PLoS One
JF - PLoS One
IS - 4
M1 - e0196003
ER -
