SETTING: Cape Town, South Africa, 2014. OBJECTIVES: 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. CONCLUSIONS: 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, Home-based treatment, Paediatric, TBM,
International Journal of Tuberculosis and Lung Disease
Department of Public Health

van Elsland, S.L, Van Dongen, S.I. (S. I.), Bosmans, J.E, Schaaf, H.S. (H. S.), van Toorn, R, & van Furth, A.M. (2018). Cost-effectiveness of home-based vs. in-hospital treatment of paediatric tuberculous meningitis. International Journal of Tuberculosis and Lung Disease, 22(10), 1188–1195. doi:10.5588/ijtld.18.0236