Table 2.
Incremental costs, DALYs averted, and ICERs∗ for interventions 2 through 10 compared to intervention 1 (base case) under selected constraint scenarios.
| Intervention (target coverage†) | Constraint scenario | Incremental costs (US dollars, thousands) | DALYs averted ( thousands) | Incremental cost per DALY averted (US dollars) |
|---|---|---|---|---|
| 2 (100% Xpert coverage) | Unconstrained | 334 654 | 299 | 1121 |
| HR (least limiting) | 334 654 | 299 | 1121 | |
| HR (medium) | 334 654 | 299 | 1121 | |
| Financial (medium) | 334 654 | 290 | 1153 | |
| Diagnostics | 189 237 | 234 | 809 | |
| 3 (90% follow-up of Xpert negatives) | Unconstrained | 73 201 | 86 | 847 |
| HR (least limiting) | 73 201 | 86 | 847 | |
| HR (medium) | 73 201 | 86 | 847 | |
| Financial (medium) | 73 201 | 86 | 847 | |
| Diagnostics | 68 411 | 85 | 806 | |
| 4 (2 + 3) | Unconstrained | 417 027 | 381 | 1093 |
| HR (least limiting) | 417 027 | 381 | 1093 | |
| HR (medium) | 417 027 | 381 | 1093 | |
| Financial (medium) | 417 027 | 381 | 1093 | |
| Diagnostics | 268 375 | 318 | 844 | |
| 5 (cough triage in 100% of patients with HIV) | Unconstrained | –496 799 | 34 | –14 588 |
| HR (least limiting) | –496 799 | 34 | –14 588 | |
| HR (medium) | –496 799 | 34 | –14 588 | |
| Financial (medium) | –496 799 | 34 | –14 588 | |
| Diagnostics | –395 416 | 89 | –4425 | |
| 6 (cough triage in 90% PHC patients) | Unconstrained | 525 977 | 255 | 2061 |
| HR (least limiting) | 525 514 | 255 | 2060 | |
| HR (medium) | 126 528 | 56 | 2248 | |
| Financial (medium) | 525 977 | 255 | 2061 | |
| Diagnostics | 91 886 | 46 | 1989 | |
| 7 (WHO screener in 100% of patients with HIV) | Unconstrained | 2 693 662 | 649 | 4148 |
| HR (least limiting) | 1 359 565 | 420 | 3241 | |
| HR (medium) | 130 455 | 52 | 2489 | |
| Financial (medium) | 2 693 662 | 649 | 4148 | |
| Diagnostics | 128 738 | 56 | 2303 | |
| 8 (WHO screener in 90% PHC patients) | Unconstrained | 3 800 388 | 907 | 4190 |
| HR (least limiting) | 463 344 | 27 | 17 201 | |
| HR (medium) | 170 109 | -78 | –2193 | |
| Financial (medium) | 3 800 388 | 907 | 4190 | |
| Diagnostics | –31 106 | -102 | 304‡ | |
| 9 (4 + 6) | Unconstrained | 988 363 | 620 | 1595 |
| HR (least limiting) | 987 853 | 619 | 1595 | |
| HR (medium) | 512 389 | 414 | 1237 | |
| Financial (medium) | 988 363 | 620 | 1595 | |
| Diagnostics | 335 806 | 345 | 972 | |
| 10 (4 + 8) | Unconstrained | 4 631 162 | 1,222 | 3789 |
| HR (least limiting) | 932 298 | 401 | 2327 | |
| HR (medium) | 606 355 | 303 | 2004 | |
| Financial (medium) | 4 606 292 | 1,220 | 3776 | |
| Diagnostics | 123 317 | 212 | 582 |
DALYs indicate disability-adjusted life years; GDP, gross domestic product; HR: human resources; ICER, incremental cost-effectiveness ratio; PHC, primary healthcare.
Note. Dominant interventions shown on expansion path. Strongly (costlier, less effective than another individual intervention) and weakly (costlier, less effective than a combination of nonmutually exclusive interventions) dominated interventions shown in lighter shade.
Cumulative values for 20-year analytic horizon (2016-2035) discounted at 3% per year. All costs reported in 2016 US dollars.
Target coverage refers to the coverage achievable under the unconstrained scenario.
Scenario produces negative costs and health benefits compared to base case. Reported ICER represents the costs and effects of moving from scenario to base case, as opposed to the other comparisons.
Adapted from Bozzani et al (2018)18