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Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses

Author

Listed:
  • Ewan M. Tomeny

    (Liverpool School of Tropical Medicine)

  • Thomas Hampton

    (Liverpool School of Tropical Medicine
    University of Liverpool
    Malawi Liverpool Wellcome Trust Clinical Research Programme)

  • Phuong Bich Tran

    (University of Oxford)

  • Laura Rosu

    (Liverpool School of Tropical Medicine)

  • Mphatso D. Phiri

    (Liverpool School of Tropical Medicine
    Malawi Liverpool Wellcome Trust Clinical Research Programme)

  • Kathryn A. Haigh

    (University of Liverpool
    University of Cape Town)

  • Jasper Nidoi

    (Liverpool School of Tropical Medicine
    Makerere University Lung Institute)

  • Tom Wingfield

    (Liverpool School of Tropical Medicine
    Liverpool School of Tropical Medicine
    Karolinska Institutet
    Liverpool University Hospitals NHS Foundation Trust)

  • Eve Worrall

    (Liverpool School of Tropical Medicine)

Abstract

Background The disability-adjusted life year (DALY), a key metric for health resource allocation, encompasses morbidity through disability weights. Widely used in tuberculosis cost-effectiveness analysis (CEAs), DALYs play a significant role in informing intervention adopt/reject decisions. This study reviews the values and consistency of disability weights applied in tuberculosis-related CEAs. Methods We conducted a systematic review using the Tufts CEA database, updated to July 2023 with searches in Embase, Scopus and PubMed. Eligible studies needed to have included a cost-per-DALY ratio, and additionally either evaluated a tuberculosis (TB) intervention or included tuberculosis-related weights. We considered all tuberculosis health states: with/without human immunodeficiency virus (HIV) coinfection, TB treatments and treatment side effects. Data were screened and extracted independently by combinations of two authors. Findings A total of 105 studies spanning 2002–2023 across 50 countries (mainly low- and middle-income countries) were extracted. Disability weights were sourced primarily from the Global Burden of Disease (GBD; 100/165; 61%), with 17 non-GBD studies additionally referenced, along with primary derivation. Inconsistencies in the utilisation of weights were evident: of the 100 usages of GBD-sourced weights, only in 47 instances (47%) had the weight value been explicitly specified with an appropriate up-to-date reference cited (constituting 28% of all weight usages, 47/165). Sensitivity analyses on weight values had been conducted in 30% of studies (31/105). Twelve studies did not clearly specify weights or their sources; nine further calculated DALYs without morbidity. The review suggests methodological gaps in current approaches for representing important aspects of TB, including TB–HIV coinfection, treatment, drug-resistance, extrapulmonary TB and psychological impacts. We propose a set of best practice recommendations. Interpretation There is a need for increased rigour in the application, sensitivity testing and reporting of TB disability weights. Furthermore, there appears a desire among researchers to reflect elements of the tuberculosis experience beyond those allowed for by GBD disability weights.

Suggested Citation

  • Ewan M. Tomeny & Thomas Hampton & Phuong Bich Tran & Laura Rosu & Mphatso D. Phiri & Kathryn A. Haigh & Jasper Nidoi & Tom Wingfield & Eve Worrall, 2024. "Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses," PharmacoEconomics, Springer, vol. 42(11), pages 1209-1236, November.
    • Handle: RePEc:spr:pharme:v:42:y:2024:i:11:d:10.1007_s40273-024-01410-x
    DOI: 10.1007/s40273-024-01410-x
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