Feasibility and Cost-effectiveness of Treating Multidrug-resistant Tuberculosis: a Cohort Study in the Philippines

Overview

Journal PLoS Med

Specialty General Medicine

Date 2006 Sep 14

PMID 16968123

Citations 54

Authors

Thelma E Tupasi

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

Soon will be listed here.

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.

Citing Articles

Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses.

Tomeny E, Hampton T, Tran P, Rosu L, Phiri M, Haigh K Pharmacoeconomics. 2024; 42(11):1209-1236.

PMID: 39110388 PMC: 11499453. DOI: 10.1007/s40273-024-01410-x.

Costs of Digital Adherence Technologies for Tuberculosis Treatment Support, 2018-2021.

Nsengiyumva N, Khan A, Gler M, Tonquin M, Marcelo D, Andrews M Emerg Infect Dis. 2023; 30(1):79-88.

PMID: 38146969 PMC: 10756355. DOI: 10.3201/eid3001.230427.

Factors associated with diagnostic delay of pulmonary tuberculosis among children and adolescents in Quzhou, China: results from the surveillance data 2011-2021.

Zhang Y, Zhan B, Hao X, Wang W, Zhang X, Fang C BMC Infect Dis. 2023; 23(1):541.

PMID: 37596514 PMC: 10439644. DOI: 10.1186/s12879-023-08516-1.

Costs of services and funding gap of the Bangladesh National Tuberculosis Control Programme 2016-2022: An ingredient based approach.

Hasan M, Ahmed S, Islam Z, Dorin F, Rabbani M, Mehdi G PLoS One. 2023; 18(6):e0286560.

PMID: 37267308 PMC: 10237497. DOI: 10.1371/journal.pone.0286560.

Cost of TB prevention and treatment in the Philippines in 2017.

Capeding T, Rosa J, Lam H, Gaviola D, Garfin A, Hontiveros C Int J Tuberc Lung Dis. 2022; 26(5):392-398.

PMID: 35505478 PMC: 9067429. DOI: 10.5588/ijtld.21.0622.

References

Robert J, Jarlier V, Grosset J . Outcome of multi-drug-resistant tuberculosis in France: a nationwide case-control study. Am J Respir Crit Care Med. 1999; 160(2):587-93. DOI: 10.1164/ajrccm.160.2.9901012. View

Laserson K, Thorpe L, Leimane V, Weyer K, Mitnick C, Riekstina V . Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2005; 9(6):640-5. View

Tupasi T, Quelapio M, Orillaza R, Alcantara C, Mira N, Abeleda M . DOTS-Plus for multidrug-resistant tuberculosis in the Philippines: global assistance urgently needed. Tuberculosis (Edinb). 2003; 83(1-3):52-8. DOI: 10.1016/s1472-9792(02)00072-0. View

Pablos-Mendez A, Raviglione M, Laszlo A, Binkin N, Rieder H, Bustreo F . Global surveillance for antituberculosis-drug resistance, 1994-1997. World Health Organization-International Union against Tuberculosis and Lung Disease Working Group on Anti-Tuberculosis Drug Resistance Surveillance. N Engl J Med. 1998; 338(23):1641-9. DOI: 10.1056/NEJM199806043382301. View

Gupta R, Kim J, Espinal M, Caudron J, Pecoul B, Farmer P . Public health. Responding to market failures in tuberculosis control. Science. 2001; 293(5532):1049-51. DOI: 10.1126/science.1061861. View

Migliori G, Espinal M, Danilova I, Punga V, Grzemska M, Raviglione M . Frequency of recurrence among MDR-tB cases 'successfully' treated with standardised short-course chemotherapy. Int J Tuberc Lung Dis. 2002; 6(10):858-64. View

Chan E, Laurel V, Strand M, Chan J, Huynh M, Goble M . Treatment and outcome analysis of 205 patients with multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2004; 169(10):1103-9. DOI: 10.1164/rccm.200308-1159OC. View

Gupta R, Cegielski J, Espinal M, Henkens M, Kim J, Lee J . Increasing transparency in partnerships for health--introducing the Green Light Committee. Trop Med Int Health. 2002; 7(11):970-6. DOI: 10.1046/j.1365-3156.2002.00960.x. View

Geerligs W, van Altena R, De Lange WCM , van Soolingen D, van der Werf T . Multidrug-resistant tuberculosis: long-term treatment outcome in the Netherlands. Int J Tuberc Lung Dis. 2000; 4(8):758-64. View

10.

De Jonghe E, Murray C, Chum H, Nyangulu D, Salomao A, STYBLO K . Cost-effectiveness of chemotherapy for sputum smear-positive pulmonary tuberculosis in Malawi, Mozambique and Tanzania. Int J Health Plann Manage. 1994; 9(2):151-81. DOI: 10.1002/hpm.4740090204. View

11.

Narita M, Alonso P, Lauzardo M, Hollender E, Pitchenik A, Ashkin D . Treatment experience of multidrug-resistant tuberculosis in Florida, 1994-1997. Chest. 2001; 120(2):343-8. DOI: 10.1378/chest.120.2.343. View

12.

Pathania V, Trnka L, Krejbich F, Dye C . A cost-benefit analysis of BCG revaccination in the Czech Republic. Vaccine. 1999; 17(15-16):1926-35. DOI: 10.1016/s0264-410x(98)00462-9. View

13.

Tahaoglu K, Torun T, Sevim T, Atac G, Kir A, Karasulu L . The treatment of multidrug-resistant tuberculosis in Turkey. N Engl J Med. 2001; 345(3):170-4. DOI: 10.1056/NEJM200107193450303. View

14.

Palmero D, Ambroggi M, Brea A, de Lucas M, Fulgenzi A, Martinez D . Treatment and follow-up of HIV-negative multidrug-resistant tuberculosis patients in an infectious diseases reference hospital, Buenos Aires, Argentina. Int J Tuberc Lung Dis. 2004; 8(6):778-84. View

15.

Telzak E, Sepkowitz K, Alpert P, Mannheimer S, Medard F, El-Sadr W . Multidrug-resistant tuberculosis in patients without HIV infection. N Engl J Med. 1995; 333(14):907-11. DOI: 10.1056/NEJM199510053331404. View

16.

Leimane V, Riekstina V, Holtz T, Zarovska E, Skripconoka V, Thorpe L . Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia: a retrospective cohort study. Lancet. 2005; 365(9456):318-26. DOI: 10.1016/S0140-6736(05)17786-1. View

17.

Goble M, Iseman M, Madsen L, Waite D, Ackerson L, Horsburgh Jr C . Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. N Engl J Med. 1993; 328(8):527-32. DOI: 10.1056/NEJM199302253280802. View

18.

Suarez P, Floyd K, Portocarrero J, Alarcon E, Rapiti E, Ramos G . Feasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients: a national cohort study in Peru. Lancet. 2002; 359(9322):1980-9. DOI: 10.1016/S0140-6736(02)08830-X. View

19.

Russell L, Gold M, Siegel J, Daniels N, Weinstein M . The role of cost-effectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine. JAMA. 1996; 276(14):1172-7. View

20.

Avendano M, Goldstein R . Multidrug-resistant tuberculosis: long term follow-up of 40 non-HIV-infected patients. Can Respir J. 2000; 7(5):383-9. DOI: 10.1155/2000/457905. View