Determination of the cost-effectiveness of a tuberculosis prevention program along the United States/Mexico border using Markov process modeling within a prevention effectiveness framework

Persistent Link:
http://hdl.handle.net/10150/282630
Title:
Determination of the cost-effectiveness of a tuberculosis prevention program along the United States/Mexico border using Markov process modeling within a prevention effectiveness framework
Author:
Borrego, Matthew Elvin, 1966-
Issue Date:
1998
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
A prevention effectiveness analysis framework was used to estimate the cost-effectiveness of a county administered tuberculosis prevention program along the U.S./Mexico border. The tuberculosis prevention program under study used prophylactic isoniazid therapy in patients who have tested positive for tuberculosis infection. This analysis determined the cost-effectiveness of the current program versus no program from the perspective of the county government and was modeled for two time periods; five years and 15 years post preventive therapy initiation. Costs were calculated using actual data from tuberculosis prevention and active tuberculosis treatment programs as well as hospital discharge data. The outcome of interest, cases of active tuberculosis averted, was calculated through a Monte Carlo simulated Markov process model. Average and incremental cost-effectiveness ratios were then calculated for the tuberculosis prevention program scenario. The cost-effectiveness ratios were calculated separately with the inclusion or exclusion of the tuberculosis contagion costs. The results of the cost-effectiveness ratio calculations established that the prevention of active tuberculosis cases with the tuberculosis prevention program is considerably cost-effective. Every baseline incremental cost-effectiveness ratio, across the five and 15 year analysis periods (irrespective of contagion costs) determined in this prevention effectiveness study demonstrated cost savings. Additionally, the cost savings were substantial. The results indicate that rather than incurring costs to avert active tuberculosis cases, the tuberculosis prevention program actually saves money. One-way sensitivity analyses were performed for selected parameters used in the calculation of the cost-effectiveness ratios. The cost-effective results obtained in the baseline analysis became sensitive when the percentage of patients hospitalized for tuberculosis decreased and when the preventive therapy compliance rate decreased for the 5 years post preventive treatment scenario with tuberculosis contagion costs excluded. However, when the tuberculosis contagion consequences of not having the tuberculosis prevention program were considered; the cost effectiveness and cost savings were once again realized.
Type:
text; Dissertation-Reproduction (electronic)
Keywords:
Health Sciences, Public Health.
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Graduate College; Pharmacy Practice and Science
Degree Grantor:
University of Arizona
Advisor:
Draugalis, JoLaine R.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_US
dc.titleDetermination of the cost-effectiveness of a tuberculosis prevention program along the United States/Mexico border using Markov process modeling within a prevention effectiveness frameworken_US
dc.creatorBorrego, Matthew Elvin, 1966-en_US
dc.contributor.authorBorrego, Matthew Elvin, 1966-en_US
dc.date.issued1998en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractA prevention effectiveness analysis framework was used to estimate the cost-effectiveness of a county administered tuberculosis prevention program along the U.S./Mexico border. The tuberculosis prevention program under study used prophylactic isoniazid therapy in patients who have tested positive for tuberculosis infection. This analysis determined the cost-effectiveness of the current program versus no program from the perspective of the county government and was modeled for two time periods; five years and 15 years post preventive therapy initiation. Costs were calculated using actual data from tuberculosis prevention and active tuberculosis treatment programs as well as hospital discharge data. The outcome of interest, cases of active tuberculosis averted, was calculated through a Monte Carlo simulated Markov process model. Average and incremental cost-effectiveness ratios were then calculated for the tuberculosis prevention program scenario. The cost-effectiveness ratios were calculated separately with the inclusion or exclusion of the tuberculosis contagion costs. The results of the cost-effectiveness ratio calculations established that the prevention of active tuberculosis cases with the tuberculosis prevention program is considerably cost-effective. Every baseline incremental cost-effectiveness ratio, across the five and 15 year analysis periods (irrespective of contagion costs) determined in this prevention effectiveness study demonstrated cost savings. Additionally, the cost savings were substantial. The results indicate that rather than incurring costs to avert active tuberculosis cases, the tuberculosis prevention program actually saves money. One-way sensitivity analyses were performed for selected parameters used in the calculation of the cost-effectiveness ratios. The cost-effective results obtained in the baseline analysis became sensitive when the percentage of patients hospitalized for tuberculosis decreased and when the preventive therapy compliance rate decreased for the 5 years post preventive treatment scenario with tuberculosis contagion costs excluded. However, when the tuberculosis contagion consequences of not having the tuberculosis prevention program were considered; the cost effectiveness and cost savings were once again realized.en_US
dc.typetexten_US
dc.typeDissertation-Reproduction (electronic)en_US
dc.subjectHealth Sciences, Public Health.en_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplinePharmacy Practice and Scienceen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorDraugalis, JoLaine R.en_US
dc.identifier.proquest9829370en_US
dc.identifier.bibrecord.b38554380en_US
All Items in UA Campus Repository are protected by copyright, with all rights reserved, unless otherwise indicated.