Cost effectiveness analysis of tuberculosis control strategies among migrants from Nigeria in the United Kingdom

Umar, Nisser (2015) Cost effectiveness analysis of tuberculosis control strategies among migrants from Nigeria in the United Kingdom. Doctoral thesis, University of East Anglia.

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Abstract

Background: Tuberculosis is a leading cause of morbidity and mortality in several low- and middle income countries (LMICs). Despite a decline in the burden of tuberculosis (TB) over the last century in many high-income countries (HICs), including the United Kingdom, emerging evidence in the last 10 years reveals an increasing burden attributed mainly to immigration, particularly from countries with high TB incidence like Nigeria.

Methods: Based on Nigeria, this study explores the cost-effectiveness of three TB control strategies on reducing the potential burden of TB among Nigerian migrants to the United Kingdom. The three strategies explored were: i) Chest X Ray (CXR) Screening of Nigerian migrants at United Kingdom airports; ii) Interferon Gamma Release Assay (IGRA) Screening at airports; and iii) ‘enlighten self-interest’ investment of the UK government by supporting Nigeria to scale-up her country-based TB control programme. A decision analysis model was developed to estimate the cumulative probabilities of TB-related outcomes and the cost-effectiveness of each strategy. Quality Adjusted Life Years (QALYs) were used as the utility measure, and a 3% discount was applied to all future costs.

Results: Over 91,000 Nigerian migrants were estimated to come to the United Kingdom annually over the 20 years modelled. 21.62% of these migrants were likely to be screened for TB based on the current practice (or selection) of TB screening. The average cost of TB treatment in Nigeria was estimated at US $227. The median out-of-pocket patient cost for hospitalized cases was US$166.11, while ambulatory patients paid an estimated median cost of US$94.16, equivalent to about 9-38% of their average annual income. Delay in diagnosis of TB across various settings in Nigeria was attributable to the estimated high direct and indirect costs from TB. The mean cost, to the UK government, for investment (paying the whole funding gap) 16 in scaling up TB control in Nigeria was estimated at £253.78 (SD £25.84) per Nigerian migrant coming into the UK, CXR screening at £293.41 (£102.95), IGRA screening at £690.93 (£113.45), while not doing anything ‘Nothing’ will still cost the UK government £70.29 (£31.52) per Nigerian migrant. The incremental cost-effectiveness ratio (ICER) for strategies – Investment in the Nigerian TB control, CXR, and IGRA – compared to strategy ‘Nothing’ was estimated at £2,964/QALY, £15,712/QALY and £11,429/QALY, respectively.

Conclusions: Relative to the Nigerian GDP, this study reveals a high cost of TB treatment in Nigeria, suggesting a disproportionate expenditure on TB at the expense of other competing health needs in the Nigerian health sector. The study suggests, albeit with important limitations, a potential benefit to the United Kingdom when the WHO Stop TB Strategy program is fully scaled up in Nigeria. There is potential application of the findings of this study in other high-income countries that receive large numbers of migrants, and the low-income, but higher TB incidence, countries like Nigeria.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Gillian Aldus
Date Deposited: 22 Mar 2018 13:41
Last Modified: 22 Mar 2018 13:48
URI: https://ueaeprints.uea.ac.uk/id/eprint/66555
DOI:

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