在埃塞俄比亚运行儿科肿瘤病房的成本效益。
Cost-effectiveness of running a paediatric oncology unit in Ethiopia.
机构信息
Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
出版信息
BMJ Open. 2023 Mar 14;13(3):e068210. doi: 10.1136/bmjopen-2022-068210.
OBJECTIVE
To estimate the cost-effectiveness of running a paediatric oncology unit in Ethiopia to inform the revision of the Ethiopia Essential Health Service Package (EEHSP), which ranks the treatment of childhood cancers at a low and medium priority.
METHODS
We built a decision analytical model-a decision tree-to estimate the cost-effectiveness of running a paediatric oncology unit compared with a do-nothing scenario (no paediatric oncology care) from a healthcare provider perspective. We used the recently (2018-2019) conducted costing estimate for running the paediatric oncology unit at Tikur Anbessa Specialized Hospital (TASH) and employed a mixed costing approach (top-down and bottom-up). We used data on health outcomes from other studies in similar settings to estimate the disability-adjusted life years (DALYs) averted of running a paediatric oncology unit compared with a do-nothing scenario over a lifetime horizon. Both costs and effects were discounted (3%) to the present value. The primary outcome was incremental cost in US dollars (USDs) per DALY averted, and we used a willingness-to-pay (WTP) threshold of 50% of the Ethiopian gross domestic product per capita (USD 477 in 2019). Uncertainty was tested using one-way and probabilistic sensitivity analyses.
RESULTS
The incremental cost and DALYs averted per child treated in the paediatric oncology unit at TASH were USD 876 and 2.4, respectively, compared with no paediatric oncology care. The incremental cost-effectiveness ratio of running a paediatric oncology unit was USD 361 per DALY averted, and it was cost-effective in 90% of 100 000 Monte Carlo iterations at a USD 477 WTP threshold.
CONCLUSIONS
The provision of paediatric cancer services using a specialised oncology unit is most likely cost-effective in Ethiopia, at least for easily treatable cancer types in centres with minimal to moderate capability. We recommend reassessing the priority-level decision of childhood cancer treatment in the current EEHSP.
目的
评估在埃塞俄比亚运行儿科肿瘤病房的成本效益，为修订埃塞俄比亚基本卫生服务包（EEHSP）提供信息，该服务将儿童癌症的治疗列为低优先级和中优先级。
方法
我们构建了一个决策分析模型——决策树，从医疗保健提供者的角度来评估运行儿科肿瘤病房与不作为方案（不提供儿科肿瘤护理）的成本效益。我们使用了最近（2018-2019 年）在提克里安贝萨专科医院（TASH）进行的儿科肿瘤病房运行成本估算，并采用了混合成本法（自上而下和自下而上）。我们使用了类似环境中其他研究的健康结果数据，来估算运行儿科肿瘤病房与不作为方案相比，在一生中避免的残疾调整生命年（DALYs）。所有成本和效果均按 3%贴现至现值。主要结果是每避免一个 DALY 的增量成本（以美元计），我们使用了埃塞俄比亚人均国内生产总值的 50%（2019 年为 477 美元）作为支付意愿（WTP）阈值。使用单因素和概率敏感性分析来检验不确定性。
结果
与没有儿科肿瘤护理相比，TASH 儿科肿瘤病房每治疗一个儿童的增量成本和避免的 DALYs 分别为 876 美元和 2.4。运行儿科肿瘤病房的增量成本效益比为每避免一个 DALY 花费 361 美元，在 WTP 阈值为 477 美元的 100000 次蒙特卡罗迭代中，有 90%是成本有效的。
结论
在埃塞俄比亚，使用专门的肿瘤病房提供儿科癌症服务极有可能具有成本效益，至少对于能力最小到中等的中心中容易治疗的癌症类型是如此。我们建议重新评估当前 EEHSP 中儿童癌症治疗的优先级别决策。
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