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Comparative Study
. 2006 Sep;3(9):e352.
doi: 10.1371/journal.pmed.0030352.

Feasibility and cost-effectiveness of treating multidrug-resistant tuberculosis: a cohort study in the Philippines

Thelma E Tupasi  1 , Rajesh Gupta, Ma Imelda D Quelapio, Ruth B Orillaza, Nona Rachel Mira, Nellie V Mangubat, Virgil Belen, Nida Arnisto, Lualhati Macalintal, Michael Arabit, Jaime Y Lagahid, Marcos Espinal, Katherine Floyd
Affiliations
Comparative Study

Feasibility and cost-effectiveness of treating multidrug-resistant tuberculosis: a cohort study in the Philippines

Thelma E Tupasi et al. PLoS Med. 2006 Sep.

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) is an important global health problem, and a control strategy known as DOTS-Plus has existed since 1999. However, evidence regarding the feasibility, effectiveness, cost, and cost-effectiveness of DOTS-Plus is still limited.

Methodology/principal findings: We evaluated the feasibility, effectiveness, cost, and cost-effectiveness of a DOTS-Plus pilot project established at Makati Medical Center in Manila, the Philippines, in 1999. Patients with MDR-TB are treated with regimens, including first- and second-line drugs, tailored to their drug susceptibility pattern (i.e., individualised treatment). We considered the cohort enrolled between April 1999 and March 2002. During this three-year period, 118 patients were enrolled in the project; 117 were considered in the analysis. Seventy-one patients (61%) were cured, 12 (10%) failed treatment, 18 (15%) died, and 16 (14%) defaulted. The average cost per patient treated was US3,355 dollars from the perspective of the health system, of which US1,557 dollars was for drugs, and US837 dollars from the perspective of patients. The mean cost per disability-adjusted life year (DALY) gained by the DOTS-Plus project was US242 dollars (range US85 dollars to US426 dollars).

Conclusions: Treatment of patients with MDR-TB using the DOTS-Plus strategy and individualised drug regimens can be feasible, comparatively effective, and cost-effective in low- and middle-income countries.

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Conflict of interest statement

Competing Interests: None of the authors have any financial or personal relationship with people or organizations who could inappropriately bias the study. The corresponding author had full access to all the data collected for the study.

Figures

Figure 1
Figure 1. Patient Enrollment in DOTS-Plus Project, 1 April 1999 to 31 March 2002
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References

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