1. iHEA Boston 2017 Congress,
Boston Massachusetts, USA
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)

2. 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

3. Using cost data produced by others

4. Did any of the below limitations adversely impact your efforts to extrapolate or adjust the cost data?

5. 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
SIGLE is a bibliographic database

6. Search strategy Category Key terms 1. Cost
Cost* or economic or finance
AND
2. Tuberculosis
TB or tuberculosis or MDR#TB or XDR#TB or multi?drug or “resistant tuberculosis” or “strain resistance” or “mycobacterium tuberculosis”
3. Treatment
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
Dates of studies from (28th of July)
No restrictions on country or language

7. Exclusion process Direct exclusion criteria
Evaluate direct exclusion criteria
Does not meet exclusion criteria: Considered for inclusion
Criteria reported: INCLUDE
Can easily infer (see inference rules): INCLUDE
Take to senior reviewer
Cannot infer:
Agree enough information to infer:
INCLUDE
Not enough information:
contact the author
Author responds with necessary information:
Author does not respond or does not have necessary information:
EXCLUDE
Meet exclusion criteria: EXCLUDE
Direct exclusion criteria
All modelled or secondary data sources. (No empirical data collected regarding prices and quantities))
High income countries (world bank)

8. 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
Used our search terms in the databases…
Cleaned
Looked to see if they were eligible
Records Excluded
n=14 457
Full-text articles assessed for eligibility
n=704
Full-text articles excluded, n=497
Studies included
n=207
No access, n=21
High income setting, n = 169
No (relevant) data reported, n = 272
Correspondence/editorial/ commentary/news/protocol, n = 35
Studies extracted (healthcare payer costs)
n= 75

9. 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
Snapshot
Patient costs will be assessed later

10. Studies per year (for extracted data)
14 in 2015
13 in 2013
8 in 2016 & 2012
23 in 2015, 19 in 2013 and 9 in 2016
97 substudies

11. Reporting - Scope

12. Reporting – Sampling

13. Reporting - Methods

14. Reporting – Inclusion of Costs

15. Reporting – Valuation

16. Economies of Scale, Comparison by Subgroup

17. Methods - Type of Costing, Above Service Level Costing

18. Methods – Timing, Sensitivity Analysis

19. Methods – Discount Rate, Measurement of cost

20. 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
Time lag with papers – 2016/15/14 papers
What is getting neglected? Making sure high burden countries are represented
Both top- down bottom- up separately
Being explicit about

21. 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