Comparison of cost effectiveness of directly observed treatment (DOT) and conventionally delivered treatment for tuberculosis: experience from rural South Africa

Floyd, Katherine; Wilkinson, David; Gilks, Charles F.

doi:10.1136/bmj.315.7120.1407

Cited by 80 publications

(54 citation statements)

References 12 publications

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“…These are the standard indicators used by WHO to measure programme performance 1 and have been used in many recent cost-effectiveness studies related to TB control. [22][23][24][25][26][27][28] For all strategies involving DOTS, data were compiled from RNTCP reporting forms from the start of DOTS implementa--tion and used to calculate the annual average number of patients detected and successfully treated. For non-DOTS treatment in the private sector, no data were available on treatment outcomes from either study site during the time period we considered.…”

Section: Effectivenessmentioning

confidence: 99%

Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India

Floyd

Arora

Murthy

et al. 2006

Bull World Health Organ

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Objective To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. Methods We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the public sector, private practitioners, and patients/attendants. Effectiveness was measured as the number of cases successfully treated. Findings The average cost per patient treated was US$ 111-123 for PPM-DOTS and public sector DOTS, and US$ 111-172 for non-DOTS treatment in the private sector. From the public sector's perspective, the cost per patient treated was lower in PPM-DOTS projects than in public sector DOTS programmes (US$ 24-33 versus US$ 63). DOTS implementation in either the public or private sectors improved treatment outcomes and substantially lowered costs incurred by patients and their attendants, compared to non-DOTS treatment in the private sector (US$ 50-60 for DOTS compared to over US$ 100 for non-DOTS). The average cost-effectiveness of PPM-DOTS and public sector DOTS was similar, at US$ 120-140 per patient successfully treated, compared to US$ 218-338 for non-DOTS private sector treatment. Incremental cost-effectiveness analysis showed that PPM-DOTS can improve effectiveness while also lowering costs. Conclusion PPM-DOTS can be an affordable and cost-effective approach to improving TB control in India, and can substantially lower the economic burden of TB for patients. Voir page 443 le résumé en français. En la página 444 figura un resumen en español.

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Section: Effectivenessmentioning

confidence: 99%

Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India

Floyd

Arora

Murthy

et al. 2006

Bull World Health Organ

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“…[6][7][8][9][10][11][12][13][14][15][16][17] Malawi's National TB Programme has introduced a guardian-based strategy of direct observation of treatment which has reduced costs for patients. 12 Costs to patients and their households of careseeking from illness onset to diagnosis are less well-documented.…”

Section: Introductionmentioning

confidence: 99%

Can Malawi's poor afford free tuberculosis sevices? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe

Kemp

Mann

Simwaka

et al. 2007

Bull World Health Organ

113

108

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Objective To assess the relative costs of accessing a TB diagnosis for the poor and for women in urban Lilongwe, Malawi, a setting where public health services are accessible within 6 kilometres and provided free of charge. Methods Patient and household direct and opportunity costs were assessed from a survey of 179 TB patients, systematically sampled from all public and mission health facilities in Lilongwe. Poverty status was determined from the 1998 Malawi Integrated Household Survey (MIHS). Findings On average, patients spent US$ 13 (MK 996 or 18 days' income) and lost 22 days from work while accessing a TB diagnosis. For non-poor patients, the total costs amounted to 129% of total monthly income, or 184% after food expenditures. For the poor, this cost rose to 248% of monthly income or 574% after food. When a woman or when the poor are sick, the opportunity costs faced by their households are greater. Conclusion Patient and household costs of TB diagnosis are prohibitively high even where services are provided free of charge. In scaling up TB services to reach the Millennium Development Goals, there is an urgent need to identify strategies for diagnosing TB that are cost-effective for the poor and their households.

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“…impossible and unnecessary in the simultaneous comparison between the two strategies, since DOTS has shown a better cost-benefit ratio in various studies in the literature. (11,13) Our results show that noncompliance rates were significantly lower among patients using DOTS than among those using SAT, almost reaching the target rate of 5% recommended by the Brazilian National TCP and the WHO. As previously mentioned, the risk of noncompliance was 2.3-times higher for those using SAT than for those using DOTS.…”

Section: Resultsmentioning

confidence: 56%

“…This is considered one of the best forms of intervention in terms of the cost-benefit ratio. (10)(11)(12)(13) Currently, approximately 50% of TB patients in Brazil are being treated using the DOTS strategy. In 2004, 42.6% of all TB patients in the state of São Paulo and 23.2% of all new TB cases in the city of São Paulo were treated using this strategy.…”

Section: Methodsmentioning

confidence: 99%

“…In 2004, 42.6% of all TB patients in the state of São Paulo and 23.2% of all new TB cases in the city of São Paulo were treated using this strategy. (11,13,14) In 2004, the Carapicuíba City Council made an agreement with the São Paulo State Department of Health and the United States Agency for International Development in order to implement the DOTS strategy for all TB cases in the city. After various The following variables were studied: age; gender; level of education; occupation; type of case (new or retreatment); clinical form of the disease Noncompliance with the treatment was defined as when patients with TB, 30 days after treatment initiation, missed the follow-up appointment and could not be reached, by means of notification or home visit, or when the administration of the medication was interrupted for more than 30 consecutive days.…”

Section: Methodsmentioning

confidence: 99%

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Abandono do tratamento de tuberculose utilizando-se as estratégias tratamento auto-administrado ou tratamento supervisionado no Programa Municipal de Carapicuíba, São Paulo, Brasil

Vieira¹,

Ribeiro

2008

J. bras. pneumol.

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Objective: To determine treatment noncompliance rates among patients participating in a municipal tuberculosis control program and to identify the variables related to noncompliance depending on the type of treatment strategy used. Methods: A longitudinal non-concurrent cohort study was carried out involving two cohorts of patients participating in the Tuberculosis Control Program of the city of Carapicuíba, Brazil. The first cohort comprised 173 patients with tuberculosis treated from January 1, 2003 to December 31, 2003 using self administration of treatment, and the second comprised 187 patients with tuberculosis treated from July 1, 2004 to June 30, 2005 using the directly observed therapy, short-course strategy. Results: Noncompliance rates decreased from 13.3% (self administration of treatment) to 5.9% (directly observed therapy, short-course), a significant difference (p < 0.05). For the self administration of treatment strategy, the variables significantly associated with treatment noncompliance were as follows: being an unregistered worker (relative risk [RR] = 3.06); retreatment (RR = 2.73); alcoholism (RR = 3.10); and no investigation of contacts (RR = 8.94). For the directly observed therapy, short-course strategy, no variables were significantly associated with noncompliance. Conclusion: The directly observed therapy, short-course strategy decreased noncompliance rates and produced better treatment outcomes, even when the risk factors for noncompliance were the same.

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Comparison of cost effectiveness of directly observed treatment (DOT) and conventionally delivered treatment for tuberculosis: experience from rural South Africa

Abstract: Objective: To conduct an economic evaluation of directly observed treatment (DOT) and conventionally delivered treatment for the management of new cases of tuberculosis in adults.

Cited by 80 publications

References 12 publications

Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India

Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India

Can Malawi's poor afford free tuberculosis sevices? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe

Abandono do tratamento de tuberculose utilizando-se as estratégias tratamento auto-administrado ou tratamento supervisionado no Programa Municipal de Carapicuíba, São Paulo, Brasil

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