Limits...
Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti.

Jacquet V, Morose W, Schwartzman K, Oxlade O, Barr G, Grimard F, Menzies D - BMC Public Health (2006)

Bottom Line: Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$.A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families.These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.

View Article: PubMed Central - HTML - PubMed

Affiliation: National tuberculosis control programme, Port-au-Prince, Haiti. varyj@yahoo.com

ABSTRACT

Background: Implementation of the World Health Organization's DOTS strategy (Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives.

Methods: Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$.

Results: Starting in 2003, DOTS expansion in Haiti is anticipated to cost $4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion.

Conclusion: A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.

Show MeSH

Related in: MedlinePlus

Year by year costs or savings with DOTS expansion in Haiti from societal and government perspectives. Dashed line – government perspective, solid line – societal perspective.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC1590025&req=5

Figure 2: Year by year costs or savings with DOTS expansion in Haiti from societal and government perspectives. Dashed line – government perspective, solid line – societal perspective.

Mentions: As seen in Figure 2, the DOTS expansion strategy would begin to result in societal savings within 4 years, although government savings would only begin after 15 years. A small increase in HIV sero-prevalence would result in a substantial increase in the number of TB cases, deaths, and TB-related societal costs (Figure 3), although savings with DOTS would be greater. As seen in Figure 4, societal savings would increase by more than $4 million for every 5% increase in case detection. This reflects the lower mortality that would result when more smear positive cases are detected and treated.


Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti.

Jacquet V, Morose W, Schwartzman K, Oxlade O, Barr G, Grimard F, Menzies D - BMC Public Health (2006)

Year by year costs or savings with DOTS expansion in Haiti from societal and government perspectives. Dashed line – government perspective, solid line – societal perspective.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1590025&req=5

Figure 2: Year by year costs or savings with DOTS expansion in Haiti from societal and government perspectives. Dashed line – government perspective, solid line – societal perspective.
Mentions: As seen in Figure 2, the DOTS expansion strategy would begin to result in societal savings within 4 years, although government savings would only begin after 15 years. A small increase in HIV sero-prevalence would result in a substantial increase in the number of TB cases, deaths, and TB-related societal costs (Figure 3), although savings with DOTS would be greater. As seen in Figure 4, societal savings would increase by more than $4 million for every 5% increase in case detection. This reflects the lower mortality that would result when more smear positive cases are detected and treated.

Bottom Line: Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$.A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families.These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.

View Article: PubMed Central - HTML - PubMed

Affiliation: National tuberculosis control programme, Port-au-Prince, Haiti. varyj@yahoo.com

ABSTRACT

Background: Implementation of the World Health Organization's DOTS strategy (Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives.

Methods: Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$.

Results: Starting in 2003, DOTS expansion in Haiti is anticipated to cost $4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion.

Conclusion: A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.

Show MeSH
Related in: MedlinePlus