Directly observed treatment for multidrug-resistant tuberculosis: an economic evaluation in the United States of America and South Africa


Wilton, P; Smith, RD; Coast, J; Millar, M; Karcher, A; (2001) Directly observed treatment for multidrug-resistant tuberculosis: an economic evaluation in the United States of America and South Africa. The international journal of tuberculosis and lung disease , 5 (12). pp. 1137-42. ISSN 1027-3719

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Abstract

OBJECTIVE: To estimate the cost-effectiveness of directly observed treatment compared to conventional therapy in reducing the spread of multidrug-resistant tuberculosis, for an industrialised country (represented by the United States of America) and a developing country (South Africa). METHODS: Monte Carlo analysis using published data on probability, cost and health impact. RESULTS: In both countries, directly observed treatment is the dominant strategy, yielding cost savings and improved health outcomes. Cost savings for directly observed treatment relative to conventional therapy become more significant as more expensive second-line drugs are used in treatments. CONCLUSIONS: The cost-effectiveness of directly observed treatment relative to conventional therapy is demonstrated for both the USA and South Africa. Cost savings are more pronounced (especially for South Africa) as the likelihood of multidrug-resistant tuberculosis increases and more expensive second-line therapies are used. Given that health care resources are more severely constrained in developing countries, the data contained in this study are useful in guiding the design of policies for the effective management of multidrug-resistant tuberculosis in settings with limited resources.

Item Type: Article
Keywords: Antitubercular Agents: economics: *therapeutic use, Comparative Study, Cost-Benefit Analysis, Decision Trees, Directly Observed Therapy: *economics, Evaluation Studies, Humans, Monte Carlo Method, South Africa, Treatment Outcome, Tuberculosis, Multidrug-Resistant: *drug therapy: *economics, United States, Antitubercular Agents, economics, therapeutic use, Cost-Benefit Analysis, Decision Trees, Directly Observed Therapy, economics, Evaluation Studies, Humans, Monte Carlo Method, South Africa, Treatment Outcome, Tuberculosis, Multidrug-Resistant, drug therapy, economics, United States
Faculty and Department: Faculty of Public Health and Policy
Research Centre: Antimicrobial Resistance Centre (AMR)
Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 11769772
Web of Science ID: 172895900010
URI: http://researchonline.lshtm.ac.uk/id/eprint/10068

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