Review of Tuberculosis Costing Studies: Assessing Reporting Standards and Methods
This session presents a review of TB provider studies, evaluating the quality of reporting standards and methodological variations used by authors. Discover insights on using cost data produced by others, challenges faced, and strategies for overcoming limitations in extrapolating or adjusting cost data.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
GHCC Stakeholder and Advisory Meeting Bill & Melinda Gates Foundation Boston Massachusetts, USA iHEA Boston 2017 Congress, Seattle, WA USA 8-11 November 2016 8-11 July 2017 A Review of the Quality of Tuberculosis Costing Studies Session: Introducing a Reference Case for Costing Global Health Interventions Lucy Cunnama Health Economics Unit, University of Cape Town, RSA (on behalf of the GHCC team)
What is the aim of this talk? To present a review of TB provider studies that have been assessed using a quality framework looking at the reporting standards and variation in methods used by authors
Using cost data produced by others Have you recently used cost data you did not produce? How difficult/easy to apply this data to your own purposes? Yes No 28.7 71.3 Very difficult Difficult 2.8 1.4 6.9 15.3 Neutral How difficult/easy was it to find this data? Easy 37.5 Very easy Very difficult 36.1 Difficult 1.4 5.6 19.4 Neutral Easy 44.4 29.2 Very easy 3
Did any of the below limitations adversely impact your efforts to extrapolate or adjust the cost data? No problems 5.6 Other problems 4.2 Handling capital costs (ie. discounting) 32.4 Measurement of overhead costs 50.7 Pricing (eg. valuation of volunteer time) 32.4 Allocation of shared program costs 42.3 Sampling or selection 45.1 Time frame (eg. minimum period of costing) 26.8 Reporting 38 Cost analysis 23.9 Precision of measurement of resource use 52.1 Cost ingredients (which ingredients) 60.6 Costing frame (ie. inclusion/exclusion) 43.7 Type of cost (ie. financial vs. economic) 52.1 Costing perspective (ie. societal vs. patient) 39.4 0 10 20 30 40 50 60 70 4
Electronic databases searched Pubmed, EMBASE, Medline, Econlit The National Health Service Economic Evaluation Database The Cost-effectiveness analysis Registry Electronic databases The European Association for Grey Literature Exploitation (EAGLE) The System for Information on Grey Literature in Europe (SIGLE) Documents and meeting reports from the World Bank and WHO websites Literatura Latino Americana em Ciencias da Saude or Latin American and Caribbean Health Sciences Literature (LILACS) Others Grey literature
Search strategy Category Key terms Cost* or economic or finance AND 1. Cost TB or tuberculosis or MDR#TB or XDR#TB or multi?drug or resistant tuberculosis or strain resistance or mycobacterium tuberculosis AND 2. Tuberculosis treatment or management or drugs or medication or DOTS or directly observed treatment or health system* or hospital care or epidemiology or government hospital setting or community based care or patient* perspective or isoniazid preventive therapy or IPT or prevention 3. Treatment Dates of studies from 1990-2016 (28th of July) No restrictions on country or language
Exclusion process Criteria reported: INCLUDE Does not meet exclusion criteria: Considered for inclusion Can easily infer (see inference rules): INCLUDE Agree enough information to infer: Evaluate direct exclusion criteria INCLUDE Author responds with necessary information: Cannot infer: Meet exclusion criteria: EXCLUDE Take to senior reviewer INCLUDE Not enough information: contact the author Author does not respond or does not have necessary information: EXCLUDE Direct exclusion criteria All modelled or secondary data sources. (No empirical data collected regarding prices and quantities)) High income countries (world bank)
Flowchart CEA Registry n=42 Cochrane library n=1 098 Pubmed n=5 967 EMBASE n=8 893 NHS EED n=279 Econlit n=69 Records identified through database searching n=16 348 Additional records identified through other sources n=4 945 Records after duplicates removed n=15 161 Records screened n=15 161 Records Excluded n=14 457 Full-text articles assessed for eligibility n=704 Full-text articles excluded, n=497 No access, n=21 High income setting, n = 169 No (relevant) data reported, n = 272 Correspondence/editorial/ commentary/news/protocol, n = 35 Studies included n=207 Studies extracted (healthcare payer costs) n= 75
Overall description To date, we have extracted 75 studies reporting TB provider costs Multi-field data extraction tool for both methodology and costs of studies This data set is a work in progress Published studies (peer reviewed) Any provider cost for any TB intervention Reporting standards for each item: whether explicitly mentioned, or inferred if there was enough information to make this assessment
Studies per year (for extracted data) 14 in 2015 13 in 2013 8 in 2016 & 2012 10 Number of studies per year 14 13 5 8 8 7 5 4 3 3 3 2 1 1 1 1 1 0 1998 2000 2002 2003 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year
Reporting - Scope 1 3 4 9 17 19 24 60 36 Number of studies 59 NR explicit inferred 40 55 55 48 20 30 12 3 0 Geographical_Scope Time_Period Population Incremental_vs_Full Econ_vs_Fin
Reporting Sampling 1 2 11 16 14 21 60 9 19 24 Number of studies 22 N/A NR explicit inferred 40 9 50 44 20 31 26 1 0 Country Site Area Patient
Reporting - Methods 1 6 132 172 2000 488 1500 Number of cost line items 1385 N/A NR explicit inferred 2033 1000 1527 99 500 492 95 14 0 Allocation Top_vs_Bottom Pro_vs_Retrospective
Reporting Inclusion of Costs 23 60 44 53 11 Number of studies 65 66 NR explicit inferred 40 41 20 25 10 2 4 12 7 6 6 0 Unrelated_Costs Research_Costs Above_Facility Overheads Omitted
Reporting Valuation 6 27 60 44 Number of studies 53 NR explicit inferred 40 48 20 29 16 2 0 0 Currency_Year Discount_Rate Conversion_Method
Economies of Scale, Comparison by Subgroup 50 50 40 40 30 Number of studies Number of studies 30 52 49 20 20 23 22 10 10 4 0 0 compared by SG not compared by SG analyzed discussed ignored
Methods - Type of Costing, Above Service Level Costing 40 30 40 Number of studies Number of studies 20 53 39 35 20 10 13 9 1 0 0 NR no costs included some costs included NR economic financial
Methods Timing, Sensitivity Analysis 50 40 40 30 Number of studies Number of studies 30 51 47 20 20 23 10 10 18 6 5 0 0 comprehensive limited none NR longitudinal cross sectional
Methods Discount Rate, Measurement of cost 40 1000 30 Number of cost line items Number of studies 43 1297 20 500 23 10 403 260 188 3 2 2 2 0 0 3% 3.5% 5% 8% N/A NR N/A NR mixed bottom up
Conclusions Cost data for TB from a providers perspective is available, however not all recent Reporting varies greatly some aspects reported well others not reported at all examples are overheads and allocation of costs which make it hard to extrapolate or adjust cost data Among those aspects reported, there is variation in methods such as discount rate, and use of sensitivity analyses Encouraging researchers to be explicit and transparent in how they costed interventions, Reference Case will help with this Not yet sure of the representativeness of the interventions costed in the 207 studies The final (larger) data set will assist us in assessing the current quality as well as establishing future guidance on costing
Future work Building a TB provider cost repository Formulating guidelines for TB costing Use of those guidelines By GHCC members By others in the field
