Tuberculosis (TB) unit cost data are available for low- and middle-income countries; however, there is methodological variability in how this is reported. |
There are gaps in the current tuberculosis unit cost literature, particularly for 12 high TB burden countries, TB vaccinations and the interventions of above-service costs, tuberculosis prevention, and active and intensified case finding. |
Going forward we need to consistently define interventions and follow standard methods to align work. |
1 Introduction
2 Methods
2.1 Search Strategy
Category | Search terms |
---|---|
Cost | Cost* or economic or finance AND |
Tuberculosis | TB or tuberculosis or MDR#TB or XDR#TB or multi? Drug or “resistant tuberculosis” or “strain resistance” or “mycobacterium tuberculosis” AND |
Tuberculosis health services including tuberculosis treatment and prevention | treatment or management or drugs or medication or DOTS or “directly observed treatment” or “health system*” or “hospital care” or “epidemiology” or “government hospital setting” or “community based care” or “patient* perspective” or “isoniazid preventive therapy” or “IPT” or “prevention” |
2.1.1 Data Extraction
Interventions | Quality: final study rating | Number of unit costs | Sites | Countries | Lead author | Reference year | Reported currency year |
---|---|---|---|---|---|---|---|
TB treatment | AADB | 9 | 20 | South Africa | Vassall et al. [54] | 2017 | 2014 |
TB treatment | ABAA | 23 | 8 | Brazil | Trajman et al. [60] | 2016 | 2013 |
TB treatment | ABDA | 2 | 1 | Nigeria | Musa et al. [61] | 2016 | 2014 |
TB treatment | AADB | 3 | 1 | South Africa | Naidoo et al. [62] | 2015 | 2009 |
TB treatment | AADB | 2 | 1 | South Africa | Sinanovic et al. [50] | 2015 | 2013 |
TB treatment | AACC | 1 | 5 | Nigeria | Adewole et al. [63] | 2015 | 2014 |
TB treatment | ABDB | 14 | 4 | China | Fitzpatrick et al. [25] | 2015 | 2011 |
TB treatment | AADB | 2 | NR | South Africa | Cox et al. [64] | 2015 | 2013 |
TB treatment | AADA | 3 | 1 | Malaysia | Atif et al. [43] | 2014 | 2013 |
TB treatment | ACBA | 6 | 1 | China | Xia et al. [65] | 2014 | 2009 |
TB treatment | ABDB | 3 | NR | China | Wang et al. [27] | 2014 | 2008 |
TB treatment | ABCA | 18 | 1 | Kazakhstan | Maimakov et al. [66] | 2013 | 2013 |
TB treatment | ABDB | 7 | 1 | South Africa | Pooran et al. [29] | 2013 | 2011 |
TB treatment | ABCA | 9 | 51 | China | Zou et al. [14] | 2013 | 2008 |
TB treatment | ABDB | 5 | 1 | South Africa | Schnippel et al. [15] | 2013 | 2011 |
TB treatment | ABCA | 2 | 7 | Yemen | Othman et al. [67] | 2012 | 2009 |
TB treatment | ABAA | 1 | 1 | South Africa | Janson et al. [68] | 2012 | 2009 |
TB treatment | AABA | 5 | 27 | Nigeria | Umar et al. [69] | 2011 | 2008 |
TB treatment | ABDB | 2 | 2 | Brazil | do Prado et al. [70] | 2011 | 2006 |
TB treatment | ABDC | 2 | NR | Ethiopia | Datiko et al. [71] | 2010 | 2007 |
TB treatment | ACDB | 4 | NR | India | Pantoja et al. [72] | 2009 | 2005 |
TB treatment | CADA | 8 | NR | Indonesia | Johns et al. [73] | 2009 | 2005 |
TB treatment | AAAB | 4 | 11 | Ukraine | Vassall et al. [55] | 2009 | 2003 |
TB treatment | ABCA | 7 | 3 | Nepal | Mirzoev et al. [16] | 2008 | 2002 |
TB treatment | ABAA | 1 | 1 | Malaysia | Elamin et al. [74] | 2008 | 2003 |
TB treatment | CADB | 8 | 1 | Nepal | Karki et al. K. [75] | 2007 | 2006 |
TB treatment | ABCA | 6 | 1 | South Africa | Sinanovic et al. [52] | 2006 | 2001 |
TB treatment | ABDB | 25 | NR | Russian Federation | Atun et al. [76] | 2006 | 2000 |
TB treatment | ABDB | 23 | NR | Sudan | El-Sony et al. [56] | 2006 | 2005 |
TB treatment | AACA | 5 | NR | India | Floyd et al. [44] | 2006 | 2002 |
TB treatment | ABBA | 6 | 1 | South Africa | Sinanovic et al. [51] | 2006 | 2001 |
TB treatment | AAAA | 1 | 1 | Philippines | Tupasi et al. [58] | 2006 | 2002 |
TB treatment | ABCA | 9 | 1 | Brazil | Costa et al. [77] | 2005 | 1999 |
TB treatment | AABA | 4 | 5 | United Republic of Tanzania | Wandwalo et al. [18] | 2005 | 2002 |
TB treatment | AACB | 5 | 149 | India | Muniyandi et al. [57] | 2005 | 2002 |
TB treatment | ABCB | 8 | NR | South Africa | Sinanovic et al. [49] | 2003 | 1997 |
TB treatment | ABCA | 5 | 5 | Zimbabwe | Hongoro et al. [78] | 2003 | 1999 |
TB treatment | AABA | 4 | NR | Malawi | Floyd et al. [45] | 2003 | 1998 |
TB treatment | AABA | 2 | NR | Botswana | Moalosi et al. [79] | 2003 | 1998 |
TB treatment | ABDA | 4 | 2 | Kenya | Nganda et al. [80] | 2003 | 1998 |
TB treatment | AABA | 4 | NR | Uganda | Okello et al. [19] | 2003 | 1998 |
TB treatment | ABDA | 2 | 2 | Bangladesh | Islam et al. [21] | 2002 | 1997 |
TB treatment | ABDA | 10 | 1 | Russian Federation | Jacobs et al. [81] | 2002 | 1997 |
TB treatment | ABDB | 20 | 4 | Thailand | Kamolratanakul et al. [46] | 2002 | 1997 |
TB treatment | AACB | 3 | 3 | Pakistan | Khan et al. [23] | 2002 | 1998 |
TB treatment | ABAA | 1 | 21 | Peru | Suárez et al. [20] | 2002 | 2000 |
TB treatment | AABC | 4 | 1 | South Africa | Dick et al. [82] | 1998 | 1994 |
TB treatment | ABDB | 2 | 1 | South Africa | Floyd et al. [12] | 1997 | 1996 |
TB treatment | AADA | 4 | 1 | South Africa | Wilkinson et al. [22] | 1997 | 1994 |
TB treatment | ABAA | 1 | NR | Thailand | Sawert et al. [83] | 1997 | 1995 |
TB treatment | ABCB | 2 | 1 | Uganda | Saunderson et al. [28] | 1995 | 1992 |
TB treatment | ABBA | 4 | 5 | Thailand | Kamolratanakul et al. [47] | 1993 | 1989 |
TB treatment | AACC | 4 | 4 | Thailand | Chunhaswasdikul et al. [84] | 1992 | 1991 |
TB treatment | AACB | 12 | 3 | Malawi, Mozambique, United Republic of Tanzania | Murray et al. [10] | 1991 | 1990 |
TB prevention | AABA | 4 | 29 | Brazil | Azadi et al. [35] | 2014 | 2010 |
TB prevention | AABB | 4 | 1 | Zambia | Terris-Prestholt et al. [38] | 2008 | 2007 |
TB prevention | ABAA | 1 | 1 | Uganda | Shrestha et al. [85] | 2007 | 2003 |
TB prevention | ABDB | 2 | 2 | Uganda | Aisu et al. [36] | 1995 | 1992 |
PCF | AADB | 11 | 1 | Malawi | Nliwasa et al. [30] | 2016 | 2014 |
PCF | ABBA | 22 | 21 | South Africa | Cunnama et al. [24] | 2016 | 2013 |
PCF | ABCA | 9 | 5 | Uganda | Hsiang et al. [86] | 2016 | 2014 |
PCF | AADB | 8 | 1 | Cambodia, Georgia, Kenya, Eswatini | Page et al. [8] | 2015 | 2014 |
PCF | AACC | 6 | 5 | Malawi | Zwerling et al. [87] | 2015 | 2010 |
PCF | ABDB | 4 | 1 | South Africa | van Rie et al. [13] | 2013 | 2010 |
PCF | ABCC | 8 | 4 | China | Pang et al. [88] | 2013 | 2011 |
PCF | AABB | 2 | 1 | United Republic of Tanzania | Kidenya et al. [89] | 2013 | 2011 |
PCF | AADB | 3 | 1 | Brazil | Guerra et al. [90] | 2013 | 2012 |
PCF | AADC | 3 | 1 | South Africa | Dorman et al. [91] | 2012 | 2011 |
PCF | AADB | 2 | NR | South Africa | Schnippel et al. [48] | 2012 | 2011 |
PCF | AACA | 2 | 2 | South Africa | Whitelaw et al. [92] | 2011 | 2010 |
PCF | ACDB | 7 | 10 | Ethiopia | Mesfin et al. [93] | 2010 | 2005 |
PCF | ACDB | 3 | 20 | South Africa | Fairall et al. [94] | 2010 | 2009 |
PCF | ABDB | 5 | 1 | Uganda | Ogwang et al. [31] | 2009 | 2005 |
PCF | AABB | 10 | 37 | Peru | Acuna-Villaorduna et al. [32] | 2008 | 2004 |
PCF | ABDA | 2 | 1 | Kenya | van Cleeff et al. [53] | 2005 | 2004 |
PCF | ABDA | 2 | 1 | Kenya | van Cleeff et al. [33] | 2005 | 2004 |
PCF | ABAA | 1 | 1 | Zambia | Walker et al. [95] | 2000 | 1998 |
PCF | AADB | 2 | 1 | Kenya | Roos et al. [34] | 1998 | 1997 |
ICF | ABAA | 1 | 1 | Botswana | Smith et al. [96] | 2015 | 2010 |
ICF | ABCA | 8 | NR | Kenya | Yakhelef et al. [97] | 2014 | 2009 |
ICF | CABB | 2 | 3 | South Africa | Peter et al. [98] | 2013 | 2012 |
ICF | AADB | 3 | 1 | Thailand | Ngamlert et al. [99] | 2009 | 2007 |
ICF | ABCA | 4 | 29 | Brazil | Dowdy et al. [100] | 2008 | 2006 |
ICF | AADC | 14 | 1 | South Africa | Hudson et al. [101] | 2000 | 1995 |
ACF | ABAA | 1 | NR | Cambodia | Yadav et al. [26] | 2014 | 2012 |
ACF | AACC | 4 | 5 | Cambodia | Eang et al. [102] | 2012 | 2010 |
ACF | ABCB | 3 | 1 | South Africa | Chihota et al. [103] | 2010 | 2007 |
Above-service costs | AACB | 4 | 5 | Nigeria | Abdurrahman et al. [11] | 2014 | 2012 |
ACF, TB treatment | CABB | 3 | 4 | South Africa | Zishiri et al. [104] | 2014 | 2013 |
ACF, TB treatment | AADB (AADA for TB treatment component) | 6 | 1 | Tajikistan | Winetsky et al. [105] | 2012 | 2009 |
ACF, TB treatment, TB prevention | AADB | 4 | NR | Brazil | Steffen et al. [40] | 2013 | 2010 |
ACF, TB prevention | AADB | 2 | 1 | Malaysia | Atif et al. [42] | 2012 | 2010 |
ICF, TB treatment | ABCC | 2 | 1 | South Africa | Kranzer et al. [106] | 2012 | 2011 |
ICF, TB prevention | ABCA | 6 | 1 | South Africa | Hausler et al. [37] | 2006 | 2002 |
PCF, TB treatment | ABDA | 7 | NR | South Africa | Meyer-Rath et al. [107] | 2012 | 2011 |
PCF, TB treatment | AADA (AADB for TB treatment component) | 4 | 11 | Indonesia | Mahendradhata et al. [108] | 2010 | 2005 |
PCF, TB treatment | ABAB (ABDA for TB treatment component) | 2 | 16 | Haiti | Jacquet et al. [17] | 2006 | 2003 |
PCF, TB treatment | AABB | 32 | NR | Syrian Arab Republic, Egypt | Vassall et al. [9] | 2002 | 1999 |
PCF, TB treatment | AABB | 29 | NR | Russian Federation | Khomenko A.G. [109] | 1998 | 1996 |
PCF, TB treatment, TB prevention | ABCB | 14 | NR | South Africa | Mandalakas et al. [41] | 2012 | 2009 |
PCF, ICF, ACF | AACA (AACB for ACF component) | 3 | 1 | Uganda | Sekandi et al. [110] | 2015 | 2013 |
PCF, ACF | ABBC | 8 | 105 | South Africa | Clarke et al. [111] | 2006 | 2004 |
TB prevention, PCF, TB treatment | ABDB (ABDC for PCF component) | 7 | NR | Botswana | Samandari et al. [39] | 2011 | 2008 |
2.1.2 Data Analysis
3 Results
3.1 Paper Selection
3.2 Study Characteristics
Type of interventions | Articles/reports | Unit cost estimates |
---|---|---|
Above-service costs | 1 | 4 |
Active case finding (ACF) | 9 | 20 |
Intensified case finding (ICF) | 9 | 36 |
Passive case finding (PCF) | 29 | 139 |
TB prevention | 9 | 19 |
TB treatment | 65 | 409 |
Total | 122 | 627 |
3.3 Methods Utilised in Papers
3.4 Quality Rating
Indicator | A (%) | B (%) | C (%) | D (%) |
---|---|---|---|---|
Key cost components | 96 | 0 | 4 | 0 |
Bias | 48 | 49 | 4 | 0 |
Precision | 4 | 20 | 28 | 48 |
Reporting | 38 | 49 | 14 | 0 |