Abstract
Achieving ambitious targets to address the global tuberculosis (TB) epidemic requires consideration of the impact of competing interventions for improved identification of patients with TB. Cost-effectiveness analysis (CEA) and benefit-cost analysis (BCA) are two approaches to economic evaluation that assess the costs and effects of competing alternatives. However, the differing theoretical basis and methodological approach to CEA and BCA is likely to result in alternative analytical outputs and potentially different policy interpretations. A BCA was conducted by converting an existing CEA on various combinations of TB control interventions in South Africa using a benefits transfer approach to estimate the value of statistical life (VSL) and value of statistical life year (VSLY). All combinations of interventions reduced untreated active disease compared to current TB control, reducing deaths by between 5,000 and 75,000 and resulting in net benefits of Int$3.2–Int$137 billion (ZAR18.1 billion to ZAR764 billion) over a 20-year period. This analysis contributes to development and application of BCA methods for health interventions and demonstrates that further investment in TB control in South Africa is expected to yield significant benefits. Further work is required to guide the appropriate analytical approach, interpretation and policy recommendations in the South African policy perspective and context.
Highlights
The aim of this case study is to assess the expected impact of investing in various tuberculosis (TB) control interventions in the South African context using a benefitcost analysis (BCA) approach
In addition to applying the methodological specifications developed for BCA in global health and development, the case study attempts to apply the recommendations of two linked initiatives: the IDSI Reference Case (Wilkinson et al, 2016), which provides general guidance for economic evaluation as well as guidance for cost-effectiveness analysis (CEA), and guidance from the Global Health Cost Consortium Project (Vassall et al, 2017) on health intervention and services costing
To calculate the value of mortality risk reduction, Equation (1) shows the approach to calculating the values used in the benefits transfer, where the VSLtarget is the estimated value of statistical life (VSL) in South Africa, VSLbase is the value in the originating country, income is the GNI per capita adjusted for purchasing power parity, and elasticity measures the change in the VSL associated with a change in income
Summary
The aim of this case study is to assess the expected impact of investing in various tuberculosis (TB) control interventions in the South African context using a benefitcost analysis (BCA) approach. The analysis tests preliminary recommendations for conducting BCA in the global health and development context and converts outputs of a cost-effectiveness analysis (CEA) (Bozzani et al, 2018, 2019).. The analysis tests preliminary recommendations for conducting BCA in the global health and development context and converts outputs of a cost-effectiveness analysis (CEA) (Bozzani et al, 2018, 2019).1 This approach will enable the comparison of CEA and BCA analyses of the same interventions in the same context and will provide estimates of net benefits of increased investment in TB control interventions to assist South Africa’s policy response to management of TB The analysis tests preliminary recommendations for conducting BCA in the global health and development context and converts outputs of a cost-effectiveness analysis (CEA) (Bozzani et al, 2018, 2019). This approach will enable the comparison of CEA and BCA analyses of the same interventions in the same context and will provide estimates of net benefits of increased investment in TB control interventions to assist South Africa’s policy response to management of TB
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