Christine S. M. Currie

Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence

BackgroundThe HIV epidemic has caused a dramatic increase in tuberculosis (TB) in East and southern Africa. Several strategies have the potential to reduce the burden of TB in high HIV prevalence settings, and cost and cost-effectiveness analyses can help to prioritize them when budget constraints exist. However, published cost and cost-effectiveness studies are limited.MethodsOur objective was to compare the cost, affordability and cost-effectiveness of seven strategies for reducing the burden of TB in countries with high HIV prevalence. A compartmental difference equation model of TB and HIV and recent cost data were used to assess the costs (year 2003 US

OR in developing countries: A review

prices) and effects (TB cases averted, deaths averted, DALYs gained) of these strategies in Kenya during the period 2004–2023.ResultsThe three lowest cost and most cost-effective strategies were improving TB cure rates, improving TB case detection rates, and improving both together. The incremental cost of combined improvements to case detection and cure was below US

Optimal pricing policies for perishable products

15 million per year (7.5% of year 2000 government health expenditure); the mean cost per DALY gained of these three strategies ranged from US

Maximizing revenue in the airline industry under one-way pricing

18 to US

Choice-based demand management and vehicle routing in E-fulfillment

34. Antiretroviral therapy (ART) had the highest incremental costs, which by 2007 could be as large as total government health expenditures in year 2000. ART could also gain more DALYs than the other strategies, at a cost per DALY gained of around US

Modeling tuberculosis in areas of high HIV prevalence

260 to US

Dynamic pricing of airline tickets with competition

530. Both the costs and effects of treatment for latent tuberculosis infection (TLTI) for HIV+ individuals were low; the cost per DALY gained ranged from about US

Optimization by simulation metamodelling methods

85 to US

Incorporating household structure into a discrete-event simulation model of tuberculosis and HIV

370. Averting one HIV infection for less than US

Resampling methods of analysis in simulation studies

250 would be as cost-effective as improving TB case detection and cure rates to WHO target levels.ConclusionTo reduce the burden of TB in high HIV prevalence settings, the immediate goal should be to increase TB case detection rates and, to the extent possible, improve TB cure rates, preferably in combination. Realising the full potential of ART will require substantial new funding and strengthening of health system capacity so that increased funding can be used effectively.