2017年-世界发展银行全球_Optimizing_Investments_in_Belarus_Tuberculosis_Response_97页_4mb

报告摘要

Summary of "Optimizing Investments in Belarus’ Tuberculosis Response"

Core Content

This report presents an allocative efficiency analysis of Belarus’ tuberculosis (TB) response, conducted using the Optima-TB model between 2016 and 2017. It evaluates the current TB spending and outlines optimized allocation strategies to achieve better health outcomes with the same budget. The analysis aims to support strategic decision-making in TB investment and reform, particularly in the context of the Sustainable Development Goals (SDGs) and the World Health Organization (WHO) End TB Strategy.

Main Points

1. Current TB Situation in Belarus

TB incidence, prevalence, and deaths have declined in Belarus between 2000 and 2015.
However, the proportion of multi-drug resistant (MDR) and extensively drug-resistant (XDR) TB cases has increased.
TB treatment success rates are:
- 88% for new and relapse cases (2014 cohort),
- 54% for MDR-TB (2013 cohort),
- 38% for XDR-TB (2013 cohort).

2. National and Global Targets

National targets for 2020:
- 35% reduction in TB-related deaths,
- 12% reduction in TB incidence,
- 75% treatment success rate for MDR-TB.
Global End TB Strategy (2035):
- 90% reduction in TB incidence (or below 10/100,000),
- 95% reduction in TB deaths.

3. Current TB Spending

In 2015, Belarus allocated US$61.8 million to TB-related activities.
The current allocation is insufficient to meet the national and global targets.
Key program areas include:
- Involuntary isolation department treatment,
- Hospital-based care,
- Mass screening,
- Palliative care.
These areas are identified as high-cost and low-impact, suggesting opportunities for reallocation.

4. Alternative TB Response Scenarios

Scenario Group 1: Scaling up diagnostic and treatment coverage to 90% by 2020 is projected to avert 40% of active TB infections and 27% of TB-related deaths.
Scenario Group 2: Shifting from hospital-based to ambulatory care could reduce TB treatment costs by up to 40% and improve outcomes by 16% with provider incentives.
Scenario Group 3: Enhanced drug regimens (e.g., bedaquiline, clofazimine, linezolid) could improve XDR-TB treatment success, potentially reducing prevalence by more than half by 2035.
Scenario Group 4: More targeted screening and active case finding among high-risk groups (e.g., people living with HIV, people who inject drugs, homeless populations, etc.) could increase diagnostic yield and reduce the need for mass screening.

5. Optimized Allocations

The optimized budget allocation aims to maximize TB outcomes (reduced incidence, prevalence, and deaths) with the same funding.
Key reallocations include:
- Reducing spending on high-cost, low-impact interventions (e.g., involuntary isolation, hospital-based care, mass screening, palliative care).
- Increasing investment in:
  - Ambulatory care with provider incentives,
  - New MDR- and XDR-TB drug regimens,
  - Rapid molecular diagnostics,
  - Enhanced contact tracing and active case finding among key populations.
By 2035, the optimized allocation is projected to:
- Reduce adult TB prevalence by 45% compared to current levels,
- Reduce TB-related deaths by 60% compared to current levels,
- Reduce TB-related deaths by 70% compared to 2015 levels.

Key Recommendations

Transition from hospital-based to ambulatory care to reduce costs and improve efficiency.
Reform TB financing to move from bed-based to results-based payment systems.
Reduce involuntary isolation as it is the most expensive modality.
Prioritize targeted screening over mass screening to increase diagnostic yield.
Improve linkages between HIV and TB services due to the growing HIV epidemic.
Implement alcohol screening and brief interventions for TB patients with problematic alcohol use.
Enhance TB care and screening for prisoners post-release.
Address latent TB post-2020 to meet the 2035 incidence targets.
Conduct operational research to close strategic information gaps and inform TB reform.

Conclusion

The report concludes that optimized allocation of TB resources is essential to meet both national and global targets. The current TB spending model is inefficient and does not align with the ambitious goals of the SDGs and the End TB Strategy. By reallocating funds to higher-impact interventions, such as ambulatory care, new drug regimens, and targeted screening, Belarus can significantly improve TB outcomes while maintaining the same level of funding.

Key Information

Model used: Optima-TB developed by the Burnet Institute, University College London, and the World Bank.
Total TB spending in 2015: US$61.8 million.
Health expenditure in Belarus:
- Per capita increased from US$75 in 2000 to US$450 in 2014.
- Total health expenditure as a % of GDP was 5.7% in 2014, below regional and global averages.
Government health spending as % of total government spending: 13.8%, above regional and global averages.
Report scope: Analyzes four scenarios for TB response and provides optimized allocation strategies to improve outcomes.

Figures and Tables

Figure ES.1: Current and optimized TB resource allocation to minimize incidence, prevalence, and deaths.
Table 1.1: Overview of health expenditure in Belarus from 2000 to 2014.
Table 2.1: Modelling parameterization.
Table 2.2: National and global targets for TB.
Table 3.1: Key TB epidemiological data for Belarus (2015).
Table 5.1–5.5: Parameters for each scenario group.

Collaborators

Core team: Dzmitry Klimuk, Alena Skrahina (RSPC PT), Inna Nekrasova (RSPC MT), Sarah Jarvis, David Kedziora, Azfar Hussain (Burnet Institute), Gerard Abou Jaoude, Lara Goscé, Hassan Haghparast Bidgoli, Jolene Skordis-Worrall (UCL), Clemens Benedikt, Nicole Fraser, Feng Zhao (World Bank).
Supporting institutions: Ministry of Health, Global Fund, World Health Organization (WHO), and others.
Funding: Supported by the World Bank and the Global Fund.

Acronyms and Abbreviations

TB: Tuberculosis
MDR: Multi-drug resistant
XDR: Extensively drug-resistant
WHO: World Health Organization
SDG: Sustainable Development Goal
UHC: Universal Health Coverage
Optima-TB: Model used for allocative efficiency analysis
RSPC PT: Republican Scientific and Practice Centre for Pulmonology and Tuberculosis
RSPC MT: Republican Scientific and Practice Centre for Medical Technologies
ART: Antiretroviral therapy
DOT: Directly observed treatment
LRI: Lower respiratory infection
LTBI: Latent tuberculosis infection
NHA: National health accounts
YLL: Years of life lost
DALY: Disability-adjusted life year