Directly observed treatment for multidrug-resistant tuberculosis: an economic evaluation in the United States of America and South Africa.
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.
Wilton
P
P
Health Economics Group, School of Health Policy and Practice, University of East Anglia, Norwich, United Kingdom.
Smith
R D
RD
Coast
J
J
Millar
M
M
Karcher
A
A
D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D023801:Directly Observed Therapy / Q000191:economics*; D005069:Evaluation Studies as Topic; D006801:Humans; D009010:Monte Carlo Method; D013019:South Africa; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000191:economics*; D014481:United States
D000995:Antitubercular Agents