Cost-effectiveness of integrating paediatric tuberculosis services into child healthcare services in Africa: a modelling analysis of a cluster-randomised trial
Background In 2021, over one million children developed tuberculosis, resulting in 214 000 deaths, largely due to inadequate diagnosis and treatment. The diagnosis and treatment of tuberculosis is limited in most high-burden countries because services are highly centralised at secondary/tertiary lev...
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/9/12/e016416.full |
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| author | Peter J Dodd Nyashadzaishe Mafirakureva James Ndimbii Lise Denoeud-Ndam Millicent Ouma Martina Casenghi Appolinaire Tiam Lucie Nguimbous Stephen Siamba James Losike Caren Asibitar Joy Lochu Bentar Liwan Nicole Herrera Patrice Tchendjou Albert Kuate Leonie Simo Boris Kevin Tchounga Rose Otieno-Masaba Sushant Mukherjee Desire A Cheugoue Loic Feuzeu Sandrine Kwedi Muhamed Mbunka Giscard N Nana Ferdinand Ngong Bernadette Ngum Pascal Nyamb Pierrette Omgba Yanique B Tchouga Nicholas E Ekuwom Elvirah R Emuhaya Linda A Haga Gilchrist Lokoel Kennedy O Ojowi Mercy A Ojwang Saint Just Petnga |
| author_facet | Peter J Dodd Nyashadzaishe Mafirakureva James Ndimbii Lise Denoeud-Ndam Millicent Ouma Martina Casenghi Appolinaire Tiam Lucie Nguimbous Stephen Siamba James Losike Caren Asibitar Joy Lochu Bentar Liwan Nicole Herrera Patrice Tchendjou Albert Kuate Leonie Simo Boris Kevin Tchounga Rose Otieno-Masaba Sushant Mukherjee Desire A Cheugoue Loic Feuzeu Sandrine Kwedi Muhamed Mbunka Giscard N Nana Ferdinand Ngong Bernadette Ngum Pascal Nyamb Pierrette Omgba Yanique B Tchouga Nicholas E Ekuwom Elvirah R Emuhaya Linda A Haga Gilchrist Lokoel Kennedy O Ojowi Mercy A Ojwang Saint Just Petnga |
| collection | DOAJ |
| description | Background In 2021, over one million children developed tuberculosis, resulting in 214 000 deaths, largely due to inadequate diagnosis and treatment. The diagnosis and treatment of tuberculosis is limited in most high-burden countries because services are highly centralised at secondary/tertiary levels and are managed in a vertical, non-integrated way. To improve case detection and treatment among children, the World Health Organisation (WHO) recommends decentralised and integrated tuberculosis care models. The Integrating Paediatric TB Services Into Child Healthcare Services in Africa (INPUT) stepped-wedge cluster-randomised trial evaluated the impact of integrating tuberculosis services into healthcare for children under five in Cameroon and Kenya, compared with usual care, finding a 10-fold increase in tuberculosis case detection in Cameroon but no effect in Kenya.Methods We estimated intervention impact on healthcare outcomes, resource use, health system costs and cost-effectiveness relative to the standard of care (SoC) using a decision tree analytical approach and data from the INPUT trial. INPUT trial data on cascades, resource use and intervention diagnostic rate ratios were used to parametrise the decision tree model. Health outcomes following tuberculosis treatment were modelled in terms of mortality and disability-adjusted life-years (DALYs).Findings For every 100 children starting antituberculosis treatment under SoC, an additional 876 (95% uncertainty interval (UI) −76 to 5518) in Cameroon and −6 (95% UI −61 to 96) in Kenya would start treatment under the intervention. Treatment success would increase by 5% in Cameroon and 9% in Kenya under the intervention compared with SoC. An estimated 350 (95% UI −31 to 2204) and 3 (95% UI −22 to 48) deaths would be prevented in Cameroon and Kenya, respectively. The incremental cost-effectiveness ratio for the intervention compared with SoC was US$506 and US$1299 per DALY averted in Cameroon and Kenya, respectively.Interpretation Although likely to be effective, the cost-effectiveness of integrating tuberculosis services into child healthcare services depends on baseline service coverage, tuberculosis detection and treatment outcomes. |
| format | Article |
| id | doaj-art-ff91e42ab6be4d31b9a3311f9ed4fd9f |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-ff91e42ab6be4d31b9a3311f9ed4fd9f2025-08-20T02:37:17ZengBMJ Publishing GroupBMJ Global Health2059-79082024-12-0191210.1136/bmjgh-2024-016416Cost-effectiveness of integrating paediatric tuberculosis services into child healthcare services in Africa: a modelling analysis of a cluster-randomised trial 0Peter J Dodd1Nyashadzaishe Mafirakureva2James Ndimbii3Lise Denoeud-Ndam4Millicent Ouma5Martina Casenghi6Appolinaire Tiam7Lucie NguimbousStephen Siamba8James LosikeCaren AsibitarJoy LochuBentar LiwanNicole Herrera9Patrice Tchendjou10Albert Kuate11Leonie Simo12Boris Kevin Tchounga13Rose Otieno-Masaba14Sushant Mukherjee15Desire A CheugoueLoic FeuzeuSandrine KwediMuhamed MbunkaGiscard N NanaFerdinand NgongBernadette NgumPascal NyambPierrette OmgbaYanique B TchougaNicholas E EkuwomElvirah R EmuhayaLinda A HagaGilchrist LokoelKennedy O OjowiMercy A OjwangSaint Just PetngaNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USAScHARR, The University of Sheffield, Sheffield, UKScHARR, The University of Sheffield, Sheffield, UK4 Research, Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya5 Research, Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland4 Research, Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, KenyaElizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland2 Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USAElizabeth Glaser Pediatric AIDS Foundation, Nairobi, KenyaElizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USAElizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon6 National Tuberculosis Control Program, Ministry of Public Health, Yaoundé, Cameroon8 Program, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, CameroonResearch, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, CameroonResearch, Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, KenyaElizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USABackground In 2021, over one million children developed tuberculosis, resulting in 214 000 deaths, largely due to inadequate diagnosis and treatment. The diagnosis and treatment of tuberculosis is limited in most high-burden countries because services are highly centralised at secondary/tertiary levels and are managed in a vertical, non-integrated way. To improve case detection and treatment among children, the World Health Organisation (WHO) recommends decentralised and integrated tuberculosis care models. The Integrating Paediatric TB Services Into Child Healthcare Services in Africa (INPUT) stepped-wedge cluster-randomised trial evaluated the impact of integrating tuberculosis services into healthcare for children under five in Cameroon and Kenya, compared with usual care, finding a 10-fold increase in tuberculosis case detection in Cameroon but no effect in Kenya.Methods We estimated intervention impact on healthcare outcomes, resource use, health system costs and cost-effectiveness relative to the standard of care (SoC) using a decision tree analytical approach and data from the INPUT trial. INPUT trial data on cascades, resource use and intervention diagnostic rate ratios were used to parametrise the decision tree model. Health outcomes following tuberculosis treatment were modelled in terms of mortality and disability-adjusted life-years (DALYs).Findings For every 100 children starting antituberculosis treatment under SoC, an additional 876 (95% uncertainty interval (UI) −76 to 5518) in Cameroon and −6 (95% UI −61 to 96) in Kenya would start treatment under the intervention. Treatment success would increase by 5% in Cameroon and 9% in Kenya under the intervention compared with SoC. An estimated 350 (95% UI −31 to 2204) and 3 (95% UI −22 to 48) deaths would be prevented in Cameroon and Kenya, respectively. The incremental cost-effectiveness ratio for the intervention compared with SoC was US$506 and US$1299 per DALY averted in Cameroon and Kenya, respectively.Interpretation Although likely to be effective, the cost-effectiveness of integrating tuberculosis services into child healthcare services depends on baseline service coverage, tuberculosis detection and treatment outcomes.https://gh.bmj.com/content/9/12/e016416.full |
| spellingShingle | Peter J Dodd Nyashadzaishe Mafirakureva James Ndimbii Lise Denoeud-Ndam Millicent Ouma Martina Casenghi Appolinaire Tiam Lucie Nguimbous Stephen Siamba James Losike Caren Asibitar Joy Lochu Bentar Liwan Nicole Herrera Patrice Tchendjou Albert Kuate Leonie Simo Boris Kevin Tchounga Rose Otieno-Masaba Sushant Mukherjee Desire A Cheugoue Loic Feuzeu Sandrine Kwedi Muhamed Mbunka Giscard N Nana Ferdinand Ngong Bernadette Ngum Pascal Nyamb Pierrette Omgba Yanique B Tchouga Nicholas E Ekuwom Elvirah R Emuhaya Linda A Haga Gilchrist Lokoel Kennedy O Ojowi Mercy A Ojwang Saint Just Petnga Cost-effectiveness of integrating paediatric tuberculosis services into child healthcare services in Africa: a modelling analysis of a cluster-randomised trial BMJ Global Health |
| title | Cost-effectiveness of integrating paediatric tuberculosis services into child healthcare services in Africa: a modelling analysis of a cluster-randomised trial |
| title_full | Cost-effectiveness of integrating paediatric tuberculosis services into child healthcare services in Africa: a modelling analysis of a cluster-randomised trial |
| title_fullStr | Cost-effectiveness of integrating paediatric tuberculosis services into child healthcare services in Africa: a modelling analysis of a cluster-randomised trial |
| title_full_unstemmed | Cost-effectiveness of integrating paediatric tuberculosis services into child healthcare services in Africa: a modelling analysis of a cluster-randomised trial |
| title_short | Cost-effectiveness of integrating paediatric tuberculosis services into child healthcare services in Africa: a modelling analysis of a cluster-randomised trial |
| title_sort | cost effectiveness of integrating paediatric tuberculosis services into child healthcare services in africa a modelling analysis of a cluster randomised trial |
| url | https://gh.bmj.com/content/9/12/e016416.full |
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