Social, economic and operational research on tuberculosis: recent studies and some priority questions

Abstract

Social, economic and operational research has already contributed to the growing global awareness of the neglected burden of tuberculosis on individuals, families and communities. These studies have also illustrated that short-course chemotherapy for smear-positive pulmonary tuberculosis is a highly cost-effective tool for combatting tuberculosis. In the present work, the author examines the costs and effectiveness of the national tuberculosis programmes in Malawi, Mozambique and Tanzania. Chemotherapy for smear-positive tuberculosis is found to be among the most cost-effective health interventions known, costing 1-4 US dollars per year of life saved. In all situations, short-course chemotherapy is found to be more cost-effective than standard 12-month chemotherapy. General conclusions about the role of hospitalization are difficult to make; its cost-effectiveness depends on local patterns of compliance and the cost of hospitalization. Because more than three-quarters of the benefits of chemotherapy for smear-positive tuberculosis are due to transmission reduction, treating HIV sero-positives, smear-positives is probably cost-effective.

PIP: Annually over the period 1985-90, 7.3 million new cases of tuberculosis and 2.7 million deaths are expected to develop in the developing world. Despite this high degree of morbidity and mortality, tuberculosis has been given insufficient attention over the past 2 decades. Research has, however, helped renew international interest in the disease. At the microlevel, studies have demonstrated the high cost-effectiveness of short-course chemotherapy in treating smear-positive pulmonary tuberculosis. This paper considers the costs and effectiveness of national tuberculosis programs in Malawi, Mozambique, and Tanzania, and finds short-course chemotherapy to be among the most cost-effective health interventions known. Such treatment is able to save 1 year of life at the cost of us $1-4. Short-course chemotherapy is more cost-effective than standard 12-month chemotherapy. The cost-effectiveness of hospitalization depends upon local patterns of compliance and the cost of hospitalization. In sum, it is probably cost-effective to treat HIV seropositive, smear-positive individuals.