Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA.
Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands; Department of Global Health, Academic Medical Center, University of Amsterdam, Netherlands; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Lancet Glob Health. 2016 Nov;4(11):e816-e826. doi: 10.1016/S2214-109X(16)30265-0. Epub 2016 Oct 6.
The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa.
We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice.
Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective.
Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary.
Bill & Melinda Gates Foundation.
2015 年后终结结核病战略为 2025 年设定了将结核病发病率降低 50%和死亡率降低 75%的全球目标。我们旨在评估在中国、印度和南非实现这些目标的资源需求和成本效益。
我们检查了与国家利益攸关方协商制定的干预方案，这些方案将现有干预措施扩大到 2025 年的高但可行的覆盖范围。九个独立的建模小组合作评估政策结果，我们通过综合服务利用估计、经验成本数据以及对实施策略的专家意见来估算每个方案的成本。我们估计了 2016-2035 年的健康效果（即避免的残疾调整生命年）和资源影响，包括患者自付费用。为了评估资源需求和成本效益，我们将方案与代表持续当前实践的基础案例进行了比较。
递增的结核病服务成本因方案和国家而异，在某些情况下，甚至超过了现有资金需求的两倍。总的来说，扩大结核病服务大大降低了患者自付费用，并且在印度和中国，从社会角度来看，大多数干预措施都产生了净成本节约。在所有三个国家，扩大获得护理的机会都带来了巨大的健康收益。与当前的实践和传统的成本效益阈值相比，大多数干预方法似乎都具有很高的成本效益。
扩大结核病服务在高负担国家似乎具有成本效益，并且可以为患者带来巨大的健康和经济效益，尽管需要大量新的资金。需要进一步努力确定每个国家的最佳干预组合。
比尔及梅琳达·盖茨基金会。
