Abstract
ObjectiveTo investigate the cost–effectiveness of a comprehensive programme for drug-resistant tuberculosis launched in four sites in China in 2011.MethodsIn 2011–2012, we reviewed the records of 172 patients with drug-resistant tuberculosis who enrolled in the comprehensive programme and we collected relevant administrative data from hospitals and China’s public health agency. For comparison, we examined a cohort of 81 patients who were treated for drug-resistant tuberculosis in 2006−2009. We performed a cost–effectiveness analysis, from a societal perspective, that included probabilistic uncertainty. We measured early treatment outcomes based on three-month culture results and modelled longer-term outcomes to facilitate estimation of the comprehensive programme’s cost per disability-adjusted life-year (DALY) averted.FindingsThe comprehensive programme cost 8837 United States dollars (US$) per patient treated. Low enrolment rates meant that some fixed costs were higher, per patient, than expected. Although the comprehensive programme appeared 30 times more costly than the previous one, it resulted in greater health benefits. The comprehensive programme, which cost US$ 639 (95% credible interval: 112 to 1322) per DALY averted, satisfied the World Health Organization’s criterion for a very cost–effective intervention.ConclusionThe comprehensive programme, which included rapid screening, standardized care and financial protection, improved individual outcomes for MDR tuberculosis in a cost-effective manner. To support post-2015 global heath targets, the comprehensive programme should be expanded to non-residents and other areas of China.
Highlights
China has more than halved tuberculosis prevalence and mortality since 1990, from 215 cases and 19 deaths per 100 000 population to 108 cases and 4 deaths per 100 000 population in 2010.1 in 2012, China had an estimated 59 000 notifications of multidrug-resistant (MDR) tuberculosis – resistant to both isoniazid and rifampicin – but only 1906 patients enrolled in treatment for MDR tuberculosis.[2]
Only 92 patients with MDR tuberculosis were identified over a period of 2.8 years and only 81 (88%) of those patients were started on treatment for MDR tuberculosis
The proportion of enrollees insured under the New Rural Cooperative Medical Scheme exceeded the proportion of MDR tuberculosis patients detected in the baseline programme who were insured under the same scheme
Summary
China has more than halved tuberculosis prevalence and mortality since 1990, from 215 cases and 19 deaths per 100 000 population to 108 cases and 4 deaths per 100 000 population in 2010.1 in 2012, China had an estimated 59 000 notifications of multidrug-resistant (MDR) tuberculosis – resistant to both isoniazid and rifampicin – but only 1906 patients enrolled in treatment for MDR tuberculosis.[2]. In 2011−2014, the Chinese Center for Disease Control and Prevention (CCDC) piloted a comprehensive programme for drug-resistant tuberculosis in four areas of China: Chongqing municipality, Henan province, the Inner Mongolia autonomous region and Jiangsu province.[4] The comprehensive programme included the screening of all patients with sputum-smear-positive pulmonary tuberculosis, rapid diagnosis, standardized care and financial protection against catastrophic health expenditure. In the previous baseline programme in effect in the four study areas, conventional drug-susceptibility testing was recommended for all newlydiagnosed patients with smear-positive pulmonary tuberculosis and for all previously-treated patients. Such testing was confined to previously-treated patients and new patients who could afford to cover the full costs of such testing. The non-standard treatment lasted only as long as patients were willing and able to pay for it
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