Cost-effectiveness of different treatment strategies for tuberculosis in Egypt and Syria.
METHODS
The National Tuberculosis Programmes in Egypt and Syria.


OBJECTIVE
To calculate the costs and effectiveness of alternative ways of implementing TB control in Egypt and Syria, in order to illustrate the factors influencing the cost-effectiveness of TB treatment in middle-income countries.


METHODS
We compared the costs and cure rates in Egypt and Syria of the World Health Organization recommended directly observed treatment, short-course (DOTS) strategy and alternative strategies. The study included costs both to the health services and to the patient.


RESULTS
In Egypt and Syria, the cost-effectiveness of DOTS implemented through the primary health care (PHC) system was respectively $258 and $243 per patient cured. This compares to a cost per patient cured of $297 (Egypt) and $693 (Syria) for alternative strategies implemented through specialist clinics. In Egypt, when DOTS is implemented through specialist chest clinics it costs $585 per patient cured. Hospitalisation costs either $1490, $1621 or $1699 per patient cured, depending on treatment delivery in the continuation phase.


CONCLUSIONS
This study demonstrates that the move towards DOTS integrated at the PHC level has substantially improved the effectiveness of TB treatment in Egypt and Syria, without substantially increasing costs. An analysis of the different costs and effectiveness of the variety of TB treatment strategies has enabled both National Tuberculosis Programmes to expand DOTS and implement it in a way that takes into account limited resources and local health systems.
Vassall
A
A
KITHEALTH, Royal Tropical Institute, Amsterdam, The Netherlands. a.vassall@kit.nl
Bagdadi
S
S
Bashour
H
H
Zaher
H
H
Maaren
P V
PV
D000995:Antitubercular Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D023801:Directly Observed Therapy / Q000191:economics* / Q000706:statistics & numerical data; D004534:Egypt; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D013593:Syria; D014376:Tuberculosis / Q000188:drug therapy* / Q000191:economics*
D000995:Antitubercular Agents