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The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9

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Subject: search.filters.subject.Health economics

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    Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods
    (BMJ Publishing Group, 2023-02-15) Bozzani, Fiammetta Maria; McCreesh, Nicky; Diaconu, Karin; Govender, Indira; White, Richard G; Kielmann, Karina; Grant, Alison D; Vassall, Anna
    Introduction: Nosocomial Mycobacterium tuberculosis (Mtb) transmission substantially impacts health workers, patients and communities. Guidelines for tuberculosis infection prevention and control (TB IPC) exist but implementation in many settings remains suboptimal. Evidence is needed on cost-effective investments to prevent Mtb transmission that are feasible in routine clinic environments. Methods: A set of TB IPC interventions was codesigned with local stakeholders using system dynamics modelling techniques that addressed both core activities and enabling actions to support implementation. An economic evaluation of these interventions was conducted at two clinics in KwaZulu-Natal, employing agent-based models of Mtb transmission within the clinics and in their catchment populations. Intervention costs included the costs of the enablers (eg, strengthened supervision, community sensitisation) identified by stakeholders to ensure uptake and adherence. Results: All intervention scenarios modelled, inclusive of the relevant enablers, cost less than US$200 per disability-adjusted life-year (DALY) averted and were very cost-effective in comparison to South Africa’s opportunity cost-based threshold (US$3200 per DALY averted). Two interventions, building modifications to improve ventilation and maximising use of the existing Central Chronic Medicines Dispensing and Distribution system to reduce the number of clinic attendees, were found to be cost saving over the 10-year model time horizon. Incremental cost-effectiveness ratios were sensitive to assumptions on baseline clinic ventilation rates, the prevalence of infectious TB in clinic attendees and future HIV incidence but remained highly cost-effective under all uncertainty analysis scenarios. Conclusion: TB IPC interventions in clinics, including the enabling actions to ensure their feasibility, afford very good value for money and should be prioritised for implementation within the South African health system.
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    Health economics in low income countries: adapting to the reality of the unofficial economy.
    (Elsevier, 2001) Ensor, Tim; Witter, Sophie
    There is some evidence in established market economies that health economics is having a positive impact on policy. Although many of the underlying assumptions can be questioned, the predictions made are broadly applicable to a range of relatively wealthy industrialised economies. In low and middle income countries these assumptions are often less applicable. In particular, assumptions about the regulation and functioning of public and private sector activities often fail to account for the operation of the unofficial health care sector. This paper illustrates how unofficial markets might operate in the context of the health care sector in a developing economy. In particular it examines how the motives of practitioners may be influenced by a lack of regulation and under-funding which in turn contribute to the presence of unofficial activities. Unofficial market activities could influence and distort the impact of policies commonly being pursued in many countries. Further research is required into the functioning of these markets in order to align the assumptions of policy with the reality of the developing health care sector.