COST-EFFECTIVENESS ANALYSIS OF 4RH AND 6EH IN THE CONTINUATION PHASE OF TB TREATMENT IN AFGHANISTAN

Abstract

Objective: To conduct a cost effectiveness analysis of the 4RH and 6EH TB treatment regimens in Afghanistan in 2011-2012 from the provider’s perspective. Method: The cost effectiveness analysis was conducted. The bottom-up costing method was used in the Excel program to find the unit cost of the one TB patient treated with 6EH in 2011 and with the 4RH in 2012. The outcome (effectiveness) indicator used was the number of successfully treated patients. The cost-effectiveness ratio was subsequently derived by dividing the overall cost of the program by the number of successfully treated patients. The analysis was conducted at three levels i) at the health facility level ii) at the province level and iii) at the national level. Results: From the provider’s perspective at the national level, the total cost of the 6EH TB treatment regimen implemented in 2011 was 7,327,648 USD, and the number of patients successfully treated was equal to 12601, the cost effectiveness ratio was equal to 582 USD. On the other hand, the total cost of the 4RH TB treatment regimen piloted in 2012 was 5,786,582 USD, the number of the total TB patients successfully treated was equal to 11959, and the cost effectiveness ratio was 484 USD. The difference of the CER between the two regimens was 98 USD that less spent with 4RH. The CER analyses at the province level was 121 USD for 6EH and 103 USD for 4RH, and the ratios at the health facility level for Basic Health Center, Comprehensive Health Center and District Hospital was USD192, USD64, and USD90 in 2011. And USD142, USD 45 and USD 56 for 4RH in 2012. Conclusion: The 4RH regimen has proved to be more cost effective than the 6EH regimen at all levels of analysis. The sensitivity analysis that assumes changes in the cost of drugs under the 4RH regimen only suggests that, even with a 100% increase in the cost of drugs under 4RH, the CER of 4RH is still lower that of 6EH. This implies that the national TB Program has mad right decision in switching from 6EH to 4RH as the latter is not only more cost-effectiveness now but also in the future when the price of drugs may likely to rise, the 4RH regimen would still be more cost-effective.