Drug-susceptible tuberculosis treatment cost data are available from the perspective of both providers and patients from various settings around the world. |
Multidrug-resistant tuberculosis treatment costs are not widely available, particularly not for middle- and low-income countries. |
Productivity losses were presented in 57 % of the papers, for both drug-susceptible and multidrug-resistant tuberculosis. However, methods used varied widely, reflecting the lack of clear guidelines on the best instrument and methods for this estimation. |
1 Introduction
2 Methods
2.1 Search Strategy and Data Extraction
2.2 Data Analysis
2.3 Study Quality Assessment
3 Results
3.1 Paper Selection
3.2 Study Characteristics
References | Year | Country | Interventions evaluated in study | Provider costs included | Direct patient costs included | Productivity losses included |
---|---|---|---|---|---|---|
HICs (n = 25) | ||||||
Burman et al. [38]a
| 1997 | USA | DOT vs. self-administered therapy | X | X | |
Palmer et al. [92] | 1998 | USA | Universal vs. partial DOT | X | ||
Migliori et al. [76] | 1998 | Russia | New vs. old treatment strategies | X | ||
Migliori et al. [78] | 1999 | Italy | DOT vs. DOT with staff incentives | X | X | |
Marchand et al. [93] | 1999 | Canada | Hospitalised treatment of elderly | X | ||
Weis et al. [33] | 1999 | USA | DOT vs. traditional therapy | X | ||
Wurtz and White [88] | 1999 | USA | Traditional therapy | X | ||
White and Moore-Gillon [23]a
| 2000 | UK | Hospitalised treatment | X | ||
MacIntyre et al. [94] | 2001 | Australia | Inpatient vs. outpatient therapy | X | ||
Jacobs et al. [30] | 2002 | Russia | DOTS vs. traditional treatment | X | X | X |
Rajbhandary et al. [28]b
| 2004 | USA | MDR-TB | X | X | |
Atun et al. [40] | 2006 | Russia | TB control system | X | ||
Kang et al. [31]b
| 2006 | South Korea | MDR-TB | X | X | X |
Bocchino et al. [48] | 2006 | Italy | Integrated in- and outpatient | X | ||
Burns and Harrison [39] | 2007 | New Zealand | DOT in non-resident population | X | ||
Kik et al. [29] | 2009 | Netherlands | Household costs of immigrants | X | X | |
Miller et al. [52] | 2010 | USA | Total TB costs in a Texas county | X | X | |
Montes-Santiago et al. [65] | 2010 | Spain | Hospitalisation only | X | ||
Tu et al. [95] | 2011 | Taiwan | Comparison of diagnostic methods | X | ||
Eralp et al. [51] | 2012 | UK | Screening, diagnosis and treatment | X | ||
Diel et al. [24]a
| 2012 | Germany | Hospital and outpatient | X | X | |
Floyd et al. [55]b
| 2012 | Estonia, Russia | Traditional vs. WHO approach | X | ||
Miller et al. [41]a
| 2013 | Latvia | DOTS and MDR-TB | X | ||
Marks et al. [56]b
| 2014 | USA | Hospitalisation | X | X | |
Diel et al. [87]b
| 2014 | Germany | WHO guidelines | X | X | |
UMICs (n = 29) | ||||||
Masobe et al. [43] | 1995 | South Africa | Isoniazid prophylactic therapy | X | ||
Wilkinson et al. [49] | 1997 | South Africa | DOT vs. traditional treatment | X | X | X |
Sawert et al. [77] | 1997 | Thailand | TB programme improvements | X | X | |
Dick and Henchie [26] | 1998 | South Africa | TB programme in Cape Town | X | ||
Xu et al. [60]a
| 2000 | China | DOTS vs. traditional treatment | X | ||
Suarez et al. [62]b
| 2002 | Peru | MDR-TB 2nd line drug treatment | X | ||
Kamolratanakul et al. [61]a
| 2002 | Thailand | Comparison of delivery centres | X | ||
Moalosi et al. [45] | 2003 | Botswana | Home-based vs. hospital DOT | X | X | X |
Ruiz et al. [96] | 2003 | Mexico | National costs | X | ||
Costa et al. [81]a
| 2005 | Brazil | Treatment in Salvador state | X | X | X |
Sinanovic and Kumaranayake [97] | 2006 | South Africa | Public–private partnership model | X | ||
Peralta Perez et al. [53] | 2006 | Cuba | DOTS | X | ||
Jackson et al. [98] | 2006 | China | Household costs | X | X | |
Liu et al. [99] | 2007 | China | Household costs | X | ||
Elamin et al. [72] | 2008 | Malaysia | Costs in Penang state | X | X | X |
Cusmano et al. [44] | 2009 | Argentina | DOTS | X | X | X |
Guzman-Montes et al. [100] | 2009 | Mexico | Household costs | X | X | |
Fairall et al. [42] | 2010 | South Africa | Educational outreach services | X | X | |
Rouzier et al. [86]a
| 2010 | Ecuador | Household costs | X | X | |
Steffen et al. [14] | 2010 | Brazil | DOTS vs. non-DOTS | X | X | X |
Prado et al. [80] | 2011 | Brazil | Guardians vs. heath workers | X | X | X |
Samandari et al. [101]a
| 2011 | Botswana | DOTS for DS-TB and MDR-TB | X | ||
Nieto et al. [102] | 2012 | Colombia | Increased guardian supervision | X | X | |
Schnippel et al. [57]b
| 2013 | South Africa | Hospitalised management | X | ||
Pooran et al. [25]b
| 2013 | South Africa | MDR-TB | X | ||
Zou et al. [103] | 2013 | China | DOTS incentives vs. no incentive | X | X | X |
Pan et al. [63] | 2013 | China | DOTS | X | X | |
Wei et al. [104] | 2014 | China | DOTS | X | ||
Foster et al. [105] | 2015 | South Africa | DOTS | X | X | |
LMICs (n = 17) | ||||||
Rajeswari et al. [106] | 1999 | India | Household costs | X | X | |
Khan et al. [47] | 2002 | Pakistan | Health worker vs. family | X | X | X |
Vassall et al. [46] | 2002 | Egypt, Syria | DOTS vs. previous strategies | X | X | X |
Nganda et al. [66] | 2003 | Kenya | Increased community involvement | X | X | X |
Peabody et al. [107] | 2005 | Philippines | Economic burden of TB | X | X | |
Tupasi et al. [58]b
| 2006 | Philippines | DOTS-Plus MDR-TB | X | X | |
Floyd et al. [34] | 2006 | India | Public-private mix DOTS | X | X | X |
El-Sony et al. [54] | 2006 | Sudan | Comparison of HIV+ and HIV− | X | ||
Aspler et al. [108] | 2008 | Zambia | Household costs | X | X | |
Muniyandi et al. [83] | 2008 | India | DOTS vs. non-DOTS | X | X | |
Pantoja et al. [32] | 2009 | India | Public-private mix DOTS | X | X | X |
John et al. [82] | 2009 | India | DOTS | X | X | |
Vassall et al. [35] | 2009 | Ukraine | DOTS implementation | X | X | |
Mahendradhata et al. [79] | 2010 | Indonesia | Private practitioner referral | X | X | X |
Mauch et al. [109] | 2011 | Kenya | Household costs | X | X | |
Umar et al. [110] | 2012 | Nigeria | Household costs | X | ||
Mauch [68] | 2013 | Dom. Republicc, Ghana, Vietnam | Household costs | X | X | |
LICs (n = 19) | ||||||
Saunderson [50] | 1995 | Uganda | Hospital vs. ambulatory care | X | X | X |
Maponga et al. [89] | 1996 | Zimbabwe | TB/HIV co-epidemic | X | ||
Gibson et al. [111] | 1998 | Sierra Leone | Household costs | X | ||
Wyss et al. [67] | 2001 | Tanzania | Household costs | X | X | |
Islam et al. [73] | 2002 | Bangladesh | CHW vs. no CHW | X | X | X |
Floyd et al. [36] | 2003 | Malawi | Increased community involvement | X | X | X |
Okello et al. [37] | 2003 | Uganda | Increased community involvement | X | X | X |
Wandwalo et al. [85] | 2005 | Tanzania | Community vs. health facility | X | X | X |
Jacquet et al. [64] | 2006 | Haiti | DOTS expansion | X | X | X |
Karki et al. [112] | 2007 | Nepal | Public–private partnership | X | X | X |
Mirzoev et al. [113] | 2008 | Nepal | Community vs. family observation | X | X | X |
Aye et al. [69] | 2010 | Tajikistan | Household costs | X | X | |
Datiko et al. [84] | 2010 | Ethiopia | Health extension workers | X | X | X |
Vassall et al. [74] | 2010 | Ethiopia | Collaborative TB-HIV | X | X | |
Pichenda et al. [59]a
| 2012 | Cambodia | Early diagnosis and non-hospital | X | X | X |
Laokri et al. [114] | 2013 | Burkina Faso | Household costs | X | ||
Yitayal et al. [71] | 2014 | Ethiopia | DOTS | X | X | |
Laokri et al. [115] | 2014 | Benin | DOTS | X | ||
Gospodarevskaya et al. [75] | 2014 | Bangladesh, Tanzania | DOT female community worker; DOT family | X | X |
3.3 Quality Assessment
Mean number of patients in study samplec
| Ingredient approach used for provider costs | Resource use and unit costs clearly described | Year of cost data reported | Main cost categories clearly separated | Descriptive statistics presented | Patient interviews | Methods for valuing productivity loss clearly explained | Sources for productivity losses assumptions justified | |
---|---|---|---|---|---|---|---|---|---|
Papers with provider costs only (n = 28) | |||||||||
HIC (n = 15) | 307 | 73 | 60 | 80 | 73 | 20 | NA | NA | NA |
UMIC (n = 11) | 384 | 100 | 73 | 91 | 82 | 9 | NA | NA | NA |
LMIC (n = 1) | 1797 | 0 | 0 | 0 | 100 | 0 | NA | NA | NA |
LIC (n = 1) | 300 | 100 | 0 | 100 | 0 | 0 | NA | NA | NA |
Papers with patient costs included (n = 62) | |||||||||
HIC (n = 10) | 475 | 89 | 82 | 82 | 82 | 45 | 18 | 82 | 64 |
UMIC (n = 18) | 305 | 91 | 78 | 61 | 83 | 22 | 94 | 61 | 56 |
LMIC (n = 16) | 345 | 63 | 94 | 88 | 81 | 50 | 94 | 69 | 50 |
LIC (n = 18) | 154 | 73 | 78 | 78 | 89 | 33 | 100 | 56 | 44 |
All papers | 324 | 81 | 76 | 77 | 80 | 30 | 83 | 65 | 52 |
3.3.1 Data Collection Methods
3.3.2 Provider Costs
3.3.3 Patient-Incurred Costs
3.4 Mean Costs Per Patient
Income group | Hospitalisation | Outpatient visits | Drugs | Diagnostic and monitoring tests | Otherb
| Totalc
| SDd
|
---|---|---|---|---|---|---|---|
DS-TB | |||||||
HIC (n = 19) | 11,283 (8) | 1471 (5) | 1392 (6) | 961 (7) | 3413 (5) | 14,659 (19) | 13,594 |
UMIC (n = 19) | 380 (5) | 218 (10) | 107 (14) | 69 (11) | 386 (9) | 840 (19) | 1105 |
LMIC (n = 10) | 215 (4) | 75 (6) | 39 (6) | 48 (8) | 25 (5) | 273 (10) | 212 |
LIC (n = 11) | 128 (2) | 61 (5) | 49 (8) | 19 (3) | 50 (8) | 258 (11) | 352 |
All income groups (papers = 58e) | 4909 (19) | 396 (26) | 329 (32) | 453 (26) | 744 (27) | 6667 (59) | 10,105 |
Proportion, % | 73.6 | 5.9 | 4.6 | 4.1 | 11.7 | 99.9 | |
MDR-TB | |||||||
HIC (n = 10) | 53,078 (10) | 18,720 (7) | 19,887 (8) | 1201 (6) | 1841 (3) | 83,365 (10) | 64,825 |
UMIC (n = 7) | 6056 (2) | 622 (3) | 2052 (6) | 350 (5) | 823 (5) | 5284 (7) | 3420 |
LMIC (n = 1) | 207 (1) | 218 (1) | 2930 (1) | 397 (1) | 52,567 (1) | 6313 (1) | NA |
LIC (n = 1) | NI | NI | NI | NI | NI | 1218 (1) | NA |
All income groups (papers = 18f) | 41,776 (13) | 12,102 (11) | 11,623 (15) | 779 (12) | 1356 (9) | 46219 (19) | 61,027 |
Proportion, % | 61.8 | 17.9 | 17.2 | 1.2 | 2.0 | 100.1 |
Income group | Clinic visits and clinical tests user fees | Drugs | Transport | Otherb
| Total direct costsc
| SDd
| Productivity losses | SDe
|
---|---|---|---|---|---|---|---|---|
DS-TB | ||||||||
HIC (n = 6) | 107 (1) | NI | 260 (1) | 379 (1) | 373 (2) | 106 | 2801 (6) | 2018 |
UMIC (n = 19) | 221 (9) | 62 (4) | 120 (13) | 491 (12) | 603 (18) | 868 | 600 (12) | 847 |
LMIC (n = 17) | 55 (9) | 21 (7) | 9 (4) | 47 (10) | 84 (17) | 90 | 238 (11) | 320 |
LIC (n = 19) | 49 (13) | 38 (5) | 45 (10) | 96 (16) | 155 (19) | 164 | 248 (14) | 266 |
All income groups (papers = 53f, g, h) | 101 (32) | 36 (16) | 82 (28) | 212 (39) | 432 (36) | 544 | 700 (43) | 1229 |
Proportion, % | 23.3 | 8.5 | 19.1 | 49.1 | 100.0 | |||
MDR-TB | ||||||||
HIC (n = 5) | CNI | CNI | 21 (1) | CNI | 21 (1) | NA | 49,204 (5) | 51,216 |
UMIC (n = 2) | 12 (2) | NI | 178 (2) | 470 (2) | 660 (2) | 394 | 3532 (2) | 4578 |
LMIC (n = 1) | 909 (1) | NI | NI | 707 (1) | 1616 (1) | NA | CNI | NA |
LIC (n = 1) | 103 (1) | NI | 18 (1) | 285 (1) | 406 (1) | NA | 1256 (1) | NA |
All income groups (papers = 9) | 259 (4) | NI | 99 (4) | 483 (4) | 672 (5) | 621 | 28,260 (8) | 45,605 |
Proportion, % | 30.8 | 0.0 | 11.7 | 57.4 | 99.9 |