Cost-effectiveness analyses have been conducted for many interventions for HIV/AIDS, malaria, syphilis, and tuberculosis, but they have not been conducted for all interventions that are currently recommended in all countries. To support national decision makers in the effective allocation of resources, we conducted a meta-regression analysis of published incremental cost-effectiveness ratios (ICERs) for interventions for these causes, and predicted ICERs for 14 recommended interventions for Global Fund-eligible countries. In the meta-regression analysis, we used data from the Tufts University Center for the Evaluation of Value and Risk in Health (Boston, MA, USA) Cost-Effectiveness Registries (the CEA Registry beginning in 1976 and the Global Health CEA registry beginning in 1995) up to Jan 1, 2018. To create analysis files, we standardised and mapped the data, extracted additional data from published articles, and added variables from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Then we selected ratios for interventions with a minimum of two published articles and three published ICERs that mapped to one of five GBD causes (HIV/AIDS, malaria, syphilis, drug-susceptible tuberculosis, or multi-drug resistant tuberculosis), and to a GBD country; reported a currency year during or after 1990; and for which the comparator intervention was defined as no intervention, standard of care, or placebo. Our meta-regression analysis used all available data on 25 eligible interventions, and quantified the association between ICERs and factors at country level and intervention level. We used a five-stage statistical model that was developed to synthesise evidence on cost-effectiveness analyses, and we adapted it for smaller sample sizes by grouping interventions by cause and type (ie, prevention, diagnostics, and treatment). Using the meta-regression parameters we predicted country-specific median ICERs, IQRs, and 95% uncertainty intervals in 2019 US$ per disability-adjusted life-year (DALY) for 14 currently recommended interventions. We report ICERs in league tables with gross domestic product (GDP) per capita and country-specific thresholds. The sample for the analysis was 1273 ratios from 144 articles, of which we included 612 ICERs from 106 articles in our meta-regression analysis. We predicted ICERs for antiretroviral therapy for prevention for two age groups and pregnant women, pre-exposure prophylaxis against HIV for two risk groups, four malaria prevention interventions, antenatal syphilis screening, two tuberculosis prevention interventions, the Xpert tuberculosis test, and chemotherapy for drug-sensitive tuberculosis. At the country level, ranking of interventions and number of interventions with a predicted median ICER below the country-specific threshold varied greatly. For instance, median ICERs for six of 14 interventions were below the country-specific threshold in Sudan, whereas 12 of 14 were below the country-specific threshold in Peru. Antenatal syphilis screening had the lowest median ICER among all 14 interventions in 81 (63%) of 128 countries, ranging from $3 (IQR 2–4) per DALY averted in Equatorial Guinea to $3473 (2244–5222) in Ukraine. Pre-exposure prophylaxis for HIV/AIDS for men who have sex with men had the highest median ICER among all interventions in 116 (91%) countries, ranging from $2326 (1077–4567) per DALY averted in Lesotho to $53 559 (23 841–108 534) in Maldives. Country-specific league tables highlight the interventions that offer better value per DALY averted, and can support decision making at a country level that is more tailored to available resources than GDP per capita and country-specific thresholds. Meta-regression is a promising method to synthesise cost-effectiveness analysis results and transfer them across settings. Bill & Melinda Gates Foundation.

中文翻译：

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128 个国家艾滋病毒/艾滋病、疟疾、梅毒和结核病干预措施的成本效益：荟萃回归分析


已经对艾滋病毒/艾滋病、疟疾、梅毒和结核病的许多干预措施进行了成本效益分析，但尚未对所有国家目前建议的所有干预措施进行成本效益分析。为了支持国家决策者有效分配资源，我们对已发布的针对这些原因的干预措施的增量成本效益比 (ICER) 进行了元回归分析，并预测了针对全球基金资格国家的 14 项建议干预措施的 ICER。在元回归分析中，我们使用了来自塔夫茨大学健康价值和风险评估中心（美国马萨诸塞州波士顿）成本效益登记处（1976 年开始的 CEA 登记处和 2007 年开始的全球健康 CEA 登记处）的数据。 1995 年）至 2018 年 1 月 1 日。为了创建分析文件，我们对数据进行了标准化和映射，从已发表的文章中提取了其他数据，并添加了全球疾病负担、伤害和风险因素研究 (GBD) 中的变量。然后，我们选择了至少两篇发表的文章和三篇发表的 ICER 的干预措施比率，这些比率映射到五种 GBD 原因之一（艾滋病毒/艾滋病、疟疾、梅毒、药物敏感结核病或多重耐药结核病），并映射到GBD 国家；报告 1990 年期间或之后的货币年度；对照干预被定义为无干预、标准护理或安慰剂。我们的荟萃回归分析使用了 25 项合格干预措施的所有可用数据，并量化了 ICER 与国家层面和干预措施层面的因素之间的关联。 我们使用了五阶段统计模型，该模型是为了综合成本效益分析的证据而开发的，并通过按原因和类型（即预防、诊断和治疗）对干预措施进行分组来适应较小的样本量。使用元回归参数，我们预测了 2019 年 14 种当前推荐干预措施的每伤残调整生命年 (DALY) 的特定国家中位 ICER、IQR 和 95% 不确定性区间。我们在排名表中报告 ICER，其中包含人均国内生产总值 (GDP) 和特定国家的阈值。分析样本为来自 144 篇文章的 1273 个比率，其中我们在元回归分析中纳入了来自 106 篇文章的 612 个 ICER。我们预测了用于预防两个年龄组和孕妇的抗逆转录病毒治疗的 ICER、两个危险群体的 HIV 暴露前预防、四项疟疾预防干预措施、产前梅毒筛查、两项结核病预防干预措施、Xpert 结核病检测和药物化疗的 ICER - 敏感结核病。在国家层面，预测中值 ICER 低于国家特定阈值的干预措施排名和干预措施数量差异很大。例如，苏丹 14 项干预措施中有 6 项的 ICER 中值低于国家特定阈值，而秘鲁 14 项干预措施中有 12 项低于国家特定阈值。在 128 个国家中的 81 个国家（63%）的所有 14 项干预措施中，产前梅毒筛查的 ICER 中位数最低，从赤道几内亚每避免 DALY 3 美元（IQR 2-4）到乌克兰 3473 美元（2244-5222）不等。 在 116 个国家 (91%) 的所有干预措施中，针对男男性行为者进行艾滋病毒/艾滋病暴露前预防的 ICER 中位数最高，范围从莱索托每个 DALY 避免的 2326 美元 (1077-4567) 到 53 559 美元 (23 841 –108 534）在马尔代夫。特定国家的排名表突出了干预措施，这些干预措施可以为每个可避免的伤残调整生命年提供更好的价值，并且可以支持国家一级的决策，该决策更适合于可用资源，而不是人均 GDP 和特定国家的阈值。元回归是一种很有前途的方法，可以综合成本效益分析结果并将其跨设置转移。比尔及梅琳达·盖茨基金会。