Cost-effectiveness of treating multidrug-resistant tuberculosis in treatment initiative centers and treatment follow-up centers in Ethiopia

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From: PLoS ONE(Vol. 15, Issue 7)
Publisher: Public Library of Science
Document Type: Report
Length: 3,978 words
Lexile Measure: 1370L

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Author(s): Senait Alemayehu 1, Amanuel Yigezu 1, Damen Hailemariam 2, Alemayehu Hailu 2,3,*

Introduction

Multidrug-resistance Tuberculosis (MDR-TB) remains to be a considerable challenge globally and in Ethiopia. Ethiopia is one of the top 10 high MDR-TB burden countries, and studies indicate that about 1600 new MDR-TB cases were reported in 2018 [1,2]. Treatment of patients with MDR-TB is more complicated than drug-susceptible cases because of reasons related to adherence, adverse effect of the drugs, and cost. World Health Organization (WHO) widely recommended that standard MDR-TB procedure should continue for a minimum of 20 months and at least 18 months after the patient becomes culture-negative. Chronic MDR-TB patients with extensive pulmonary disease may require treatment for 24 months or longer [1].

For a long time, MDR-TB treatment in Ethiopia has been typically delivered using the WHO DOTS-Plus model and involves prolonged inpatient treatment, more frequent monitoring of adverse drug reactions, ensures adherence, and may prevent spread within the community [3]. Recently, the Ethiopian Federal Ministry of Health (FMoH) developed a national MDR-TB treatment guideline, slightly modifying the recommendations outlined in the WHO guideline. This guide recommends two distinct approaches/level for MDR-TB treatment. The first is Treatment Initiation Centers (TIC), where patients usually are diagnosed and start the therapy. The second one is Treatment Follow-up Centers (TFC), where we follow the MDR-TB patients until they complete the MDR-TB treatment [4-6].

On the one hand, the TICs operate at the hospital level, and therefore, require designated space (i.e., inpatient ward and isolated outpatient spaces). The TICs are used for identifying MDR-TB cases, preparing the patients for the full course of the treatment, initiation of therapy with second-line drugs, and admitting severe cases and those with serious complications. On the other hand, the TFCs operate at the health center level, and they are responsible for managing all patients transferred from TIC. Besides, TFCs are accountable for the active finding of MDR-TB cases [1,7]. Although there is a direct referral linkage between TIC and TFC, there is some evidence that both can separately provide MDR treatment.

There are a few studies on the cost-effectiveness of MDR-TB treatment approaches, and the results are mixed [8]. For instance, a study from India in 2017 estimated the total treatment cost for centralized MDR treatment (hospital-based model) to be about $3390 and US$ 1724 for the decentralized model. According to this study, the decentralized model can potentially save about $1666 per case, with an ICER of US$ 2383 per QALY gained. This study showed that the decentralized treatment of MDR-TB is cost-saving compared to centralized care [9]. Another study from Nigeria estimates that facility-based MDR treatment costs $2095 for facility-based care and US$ 1535 for home-based care, a potential saving of 25% [10].

The most common MDR-TB treatment modality in Ethiopia was that patients should be admitted for the full course of the treatment duration at TIC. Recently, the national MDR-TB treatment guideline recommended a new protocol that the intensive phase should be provided at TIC, and then patients...

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Gale Document Number: GALE|A630721865