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Open Access Cost of tuberculosis treatment in low- and middle-income countries: systematic review and meta-regression

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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 providerĀ“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.
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Keywords: LMIC; cost; first-line treatment; systematic review; tuberculosis

Document Type: Research Article

Affiliations: 1: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK 2: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa 3: National Institute of Public Health (INSP), Mexico City, Mexico 4: Avenir Health, Glastonbury, CT 5: University of California, Berkeley, CA 6: University of Washington, Seattle, WA, USA

Publication date: August 1, 2020

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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