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Costing analysis of levofloxacin as antibiotic prophylaxis for pediatric household contacts of multi-drug resistant tuberculosis patients in a South African setting

Background The incidence of TB in children under 15 years, accounts for 8% of the global TB burden. In 2018, the World Health Organisation (WHO) estimated that there were approximately 11 000 multi-drug resistant (MDR) TB cases in South Africa. Despite having very clear guidelines on TB treatment pr...

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Main Author: Fortuin, Suereta
Other Authors: Wilkinson, Thomas
Format: Thesis
Language:English
Published: Department of Public Health and Family Medicine 2021
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public health
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access_status_str Open Access
author Fortuin, Suereta
author2 Wilkinson, Thomas
author_browse Fortuin, Suereta
Wilkinson, Thomas
author_facet Wilkinson, Thomas
Fortuin, Suereta
author_sort Fortuin, Suereta
collection Thesis
description Background The incidence of TB in children under 15 years, accounts for 8% of the global TB burden. In 2018, the World Health Organisation (WHO) estimated that there were approximately 11 000 multi-drug resistant (MDR) TB cases in South Africa. Despite having very clear guidelines on TB treatment programs and management, availability of inexpensive diagnostic tests, curative and preventive therapies, and the widespread use of the BCG vaccines, South Africa continues to have the highest the number of MDR-TB cases per capita. Levofloxacin is used as part of the group of fluoroquinolones in the drug regimen recommended in the treatment of MDR-TB patients. In addition to investigating the clinical impact of levofloxacin as preventative antibiotic therapy, the expected costs of the intervention will be a critical input to determining feasibility and costs effectiveness, which will inform policy and implementation considerations. Methods We performed a cost analysis on using existing data from the Tuberculosis Child Multi-drug-resistant Preventative Therapy (TB-CHAMP) trial, conducted from a TB control program perspective. We used data from 510 childhood household contacts of MDR-TB patients in South Africa that were treated with levofloxacin for 6 months as a preventative therapy for MDR-TB. In our analysis we evaluated the estimated health system cost associated with provision of levofloxacin to childhood contacts of MDRTB patients in South Africa. Results The mean total cost of treating a child household contact, irrespective of their weight band is ZAR 5,289.79. When the cost were analysed by weight categories we found that the cost increased by weight category; ZAR 2,146.78 (under 5 kg), ZAR 4,714.58 (between 5-15.9 kg) and ZAR 6,606.67 (over 16 kg). We performed a comprehensive sensitivity analysis and found that the scheduled clinic visits were the major cost driver. Aside from the scheduled visits we observed that there was an increase in additional health service utilization for children with a weight more than 5kg. Conclusion We envisage that based on our analysis we will be able to inform policy decisions about the management and prevention of childhood household contacts of MDR-TB patients in developing TB themselves.
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language eng
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license_str Not specified — see source repository
provenance_str_mv Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository
publishDate 2021
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spelling oai:open.uct.ac.za:11427/33676 Costing analysis of levofloxacin as antibiotic prophylaxis for pediatric household contacts of multi-drug resistant tuberculosis patients in a South African setting Fortuin, Suereta Wilkinson, Thomas public health Background The incidence of TB in children under 15 years, accounts for 8% of the global TB burden. In 2018, the World Health Organisation (WHO) estimated that there were approximately 11 000 multi-drug resistant (MDR) TB cases in South Africa. Despite having very clear guidelines on TB treatment programs and management, availability of inexpensive diagnostic tests, curative and preventive therapies, and the widespread use of the BCG vaccines, South Africa continues to have the highest the number of MDR-TB cases per capita. Levofloxacin is used as part of the group of fluoroquinolones in the drug regimen recommended in the treatment of MDR-TB patients. In addition to investigating the clinical impact of levofloxacin as preventative antibiotic therapy, the expected costs of the intervention will be a critical input to determining feasibility and costs effectiveness, which will inform policy and implementation considerations. Methods We performed a cost analysis on using existing data from the Tuberculosis Child Multi-drug-resistant Preventative Therapy (TB-CHAMP) trial, conducted from a TB control program perspective. We used data from 510 childhood household contacts of MDR-TB patients in South Africa that were treated with levofloxacin for 6 months as a preventative therapy for MDR-TB. In our analysis we evaluated the estimated health system cost associated with provision of levofloxacin to childhood contacts of MDRTB patients in South Africa. Results The mean total cost of treating a child household contact, irrespective of their weight band is ZAR 5,289.79. When the cost were analysed by weight categories we found that the cost increased by weight category; ZAR 2,146.78 (under 5 kg), ZAR 4,714.58 (between 5-15.9 kg) and ZAR 6,606.67 (over 16 kg). We performed a comprehensive sensitivity analysis and found that the scheduled clinic visits were the major cost driver. Aside from the scheduled visits we observed that there was an increase in additional health service utilization for children with a weight more than 5kg. Conclusion We envisage that based on our analysis we will be able to inform policy decisions about the management and prevention of childhood household contacts of MDR-TB patients in developing TB themselves. 2021-07-30T13:45:43Z 2021-07-30T13:45:43Z 2021 2021-07-30T13:45:10Z Master Thesis Masters MPH http://hdl.handle.net/11427/33676 eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences
spellingShingle public health
Fortuin, Suereta
Costing analysis of levofloxacin as antibiotic prophylaxis for pediatric household contacts of multi-drug resistant tuberculosis patients in a South African setting
thesis_degree_str Master's
title Costing analysis of levofloxacin as antibiotic prophylaxis for pediatric household contacts of multi-drug resistant tuberculosis patients in a South African setting
title_full Costing analysis of levofloxacin as antibiotic prophylaxis for pediatric household contacts of multi-drug resistant tuberculosis patients in a South African setting
title_fullStr Costing analysis of levofloxacin as antibiotic prophylaxis for pediatric household contacts of multi-drug resistant tuberculosis patients in a South African setting
title_full_unstemmed Costing analysis of levofloxacin as antibiotic prophylaxis for pediatric household contacts of multi-drug resistant tuberculosis patients in a South African setting
title_short Costing analysis of levofloxacin as antibiotic prophylaxis for pediatric household contacts of multi-drug resistant tuberculosis patients in a South African setting
title_sort costing analysis of levofloxacin as antibiotic prophylaxis for pediatric household contacts of multi drug resistant tuberculosis patients in a south african setting
topic public health
url http://hdl.handle.net/11427/33676
work_keys_str_mv AT fortuinsuereta costinganalysisoflevofloxacinasantibioticprophylaxisforpediatrichouseholdcontactsofmultidrugresistanttuberculosispatientsinasouthafricansetting

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