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. 2005 Dec 10;331(7529):1364.
doi: 10.1136/bmj.38645.660093.68. Epub 2005 Nov 10.

Cost effectiveness analysis of strategies for tuberculosis control in developing countries

Rob Baltussen  1 , Katherine Floyd, Christopher Dye
Affiliations

Cost effectiveness analysis of strategies for tuberculosis control in developing countries

Rob Baltussen et al. BMJ. .

Abstract

Objective: To assess the costs and health effects of tuberculosis control interventions in Africa and South East Asia in the context of the millennium development goals.

Design: Cost effectiveness analysis based on an epidemiological model.

Setting: Analyses undertaken for two regions classified by WHO according to their epidemiological grouping-Afr-E, countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, countries in South East Asia with high adult and high child mortality.

Data sources: Published studies, costing databases, expert opinion.

Main outcome measures: Costs per disability adjusted life year (DALY) averted in 2000 international dollars (dollarsInt).

Results: Treatment of new cases of smear-positive tuberculosis in DOTS programmes cost dollarsInt6-8 per DALY averted in Afr-E and dollarsInt7 per DALY averted in Sear-D at coverage levels of 50-95%. In Afr-E, adding treatment of smear-negative and extra-pulmonary cases at a coverage level of 95% cost dollarsInt95 per DALY averted; the addition of DOTS-Plus treatment for multidrug resistant cases cost dollarsInt123. In Sear-D, these costs were dollarsInt52 and dollarsInt226, respectively. The full combination of interventions could reduce prevalence and mortality by over 50% in Sear-D between 1990 and 2010, and by almost 50% between 2000 and 2010 in Afr-E.

Conclusions: DOTS treatment of new smear-positive cases is the first priority in tuberculosis control, including in countries with high HIV prevalence. DOTS treatment of smear-negative and extra-pulmonary cases and DOTS-Plus treatment of multidrug resistant cases are also highly cost effective. To achieve the millennium development goal for tuberculosis control, substantial extra investment is needed to increase case finding and implement interventions on a wider scale.

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Figures

Figure 1
Figure 1
Expansion path for tuberculosis interventions in Afr-E region according to average and incremental cost effectiveness. (See methods for description of interventions)
See this image and copyright information in PMC

References

    1. World Health Organization. Global tuberculosis control—surveillance, planning, financing WHO report 2005. Geneva: WHO, 2005.
    1. World Health Organization. Anti-tuberculosis drug resistance in the world report No 3, 2004. Geneva: WHO, 2005. (www.who.int/gtb/publications/drugresistance/2004/index.htm.)
    1. United Nations. United Nations millennium declaration General Assembly resolution A/RES/55/2. New York: UN, 2000.
    1. Dye C, Watt CJ, Bleed DM, Hosseini SM, Raviglione MC. Evolution of tuberculosis control and prospects for reducing tuberculosis incidence, prevalence, and deaths globally. JAMA 2005;293: 2767-75. - PubMed
    1. Murray CJ, DeJonghe E, Chum HJ, Nyangulu DS, Salomao A, Styblo K. Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries. Lancet 1991;338: 1305-8. - PubMed

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