Cost-effectiveness of home-based vs. in-hospital treatment of paediatric tuberculous meningitis.

SETTING: Cape Town, South Africa, 2014. OBJECTIVE: To assess the societal costs and cost-effectiveness of home-based vs. in-hospital treatment of paediatric tuberculous meningitis. DESIGN: This was an economic evaluation from a societal perspective using probabilistic analysis. Health care, informal care, lost productivity costs and costs in other sectors, health-related quality of life (HRQoL) and family impact were assessed during interviews with care givers, children, medical staff and management. RESULTS: Societal costs for home-based treatment were USD3857, and USD28 043 for in-hospital treatment. Home-based vs. in-hospital treatment HRQoL scores were 90.9% vs. 84.5%, while family impact scores were 94.8% vs. 73.1%. The point estimate of the incremental cost-effectiveness ratio indicated that improving HRQoL and family impact by 1% was associated with a saving of respectively USD3726 and USD1140 for home-based vs. in-hospital treatment. The probability that home-based treatment was less expensive and more effective than in-hospital treatment was 96.3% for HRQoL and 100% for family impact. CONCLUSION: Societal costs of home-based treatment were lower than for in-hospital treatment. Children treated at home had a better HRQoL and family impact scores. Home-based treatment was a cost-effective alternative to in-hospital treatment of drug-susceptible tuberculous meningitis.

Cost effectiveness calculations for the diagnosis and treatment of tuberculous meningitis.

This study illustrates how cost-effectiveness calculations provide help in decisions involving a choice between introduction of a new diagnostic procedure or a new therapy for a particular clinical problem. This type of problem is critical for areas where financial resources are limiting. Our analysis is centered on the value of diagnosis and treatment in tuberculous meningitis (Tbm) and, because of its importance to developing countries, our epidemiologic data were derived from India. When financial costs are ignored, the introduction of second line therapy (e.g., Rifampin) leads to more cures than does the introduction of even a perfect diagnostic test. However, diagnostic tests (e.g., the Bromide partition test or possibly radioassays) markedly improve case finding and to some extent increase cure rates. All affects vary markedly with the prevalence of tuberculous meningitis in the population under study. For example, net financial savings would occur were a perfect nuclear test available and conventional therapy used at a prevalence of Tbm of 30% whereas there would be a net loss if the prevalence rose to 80%. This study underscores the need for detailed studies on the radiobromide partition test and for the development of new diagnostic tests, perhaps a radioimmunoassay of either the acid fast bacillus or of an antibody to it.