Cost-effectiveness analysis of interventions for tuberculosis control: DALYs versus QALYs

Area of Science:

• Public Health
• Health Economics
• Epidemiology

Background:

• Multi-drug-resistant tuberculosis (MDR-TB) poses a significant economic burden in the European region, with nearly 72,000 cases costing approximately €536 million.
• Cost-effectiveness analyses using quality-adjusted life-years (QALYs) or disability-adjusted life-years (DALYs) are crucial for evaluating new tuberculosis (TB) control strategies.
• Current methods for deriving utility weights in QALY calculations for TB treatment lack standardization and empirical evidence, leading to variable disutility values.

Purpose of the Study:

• To highlight the need for improved methods in assessing TB health effects for economic evaluations.
• To demonstrate a more accurate approach to calculating disability-adjusted life-years (DALYs) for TB using probabilistic techniques.
• To provide a more robust health-economics rationale for investing in new TB control tools.

Main Methods:

• Focused on the assessment of DALYs as an outcome measure for economic evaluation.
• Developed an exemplary model calculation using original TB data from Germany.
• Compared standard equations with probabilistic techniques, including Monte Carlo simulation, to address uncertainty.

Main Results:

• Standard equations likely underestimate lost DALYs compared to probabilistic techniques.
• Probabilistic methods, incorporating distributions around epidemiological averages, provide more realistic DALY estimates.
• The study emphasizes the need for comprehensive methods to assess TB-related impairments.

Conclusions:

• More intricate approaches, such as probabilistic modeling, are recommended for calculating DALYs in TB.
• These advanced methods can lead to more accurate healthcare resource allocation decisions for TB control.
• The findings align with World Health Organization recommendations for improved economic evaluations in public health.