Exploring the impact of health system capacity and performance on the cost-effectiveness of new technologies for TB control in low and middle income countries

Abstract: Global and national recommendations to adopt and scale-up new technologies in low and middle income countries (LMICs) are frequently made using trial informed economic evaluations, often combined with modelling to predict outcomes in different epidemiological settings. However, both costs and outcome data collected in efficacy and demonstration trials may be substantially different than those experienced in ‘real world’ settings across the wide range of LMICs that the recommendation often applies to. In particular, efficacy and demonstration trial settings do not reflect the complex health systems and demand side constraints that may influence costs and potential effectiveness of any new technology; both of which are likely to be highly heterogeneous globally.

This seminar will present a case study of the adoption of a new diagnostic for tuberculosis control; drawing upon a series of economic evaluations done during the process from global guideline recommendation to country adoption in South Africa. In doing so, it will highlight  lessons learned in terms of data requirements, economic evaluation methods and health technology assessment (HTA) processes. The argument will be made for the need for transferability frameworks and HTA processes in LMICs that consider and assess 'real world' demand and supply side constraints to new technology adoption.