title: The long-term health and economic benefits of DOTS implementation in Ecuador.
abstract: BACKGROUND
  Between April 2001 and March 2004, the Directly Observed Therapy-Short course (DOTS) program was successfully implemented by the National Tuberculosis control program, with assistance from the Canadian Lung Association, in three provinces of Ecuador, where 52% of the population of the country reside.
  
  
  METHODS
  Markov modelling was used to project TB-related morbidity, mortality and costs if the former TB control program (status quo) had continued or if the newly expanded DOTS program is maintained over 20 years. Extensive sensitivity analyses were used to determine the effect on projected outcomes of varying key assumptions.
  
  
  RESULTS
  If DOTS is maintained over the next 20 years, we predict that 18,760 cases and 15,812 TB-related deaths will be prevented, resulting in societal savings of dollars 203 million and government savings of dollars 7.1 million (all costs in dollars US). These findings were robust in extensive sensitivity analyses. Given the initial investment of dollars 3 million for DOTS implementation, this would mean a cost of dollars 190 per life saved.
  
  
  CONCLUSIONS
  Implementation of DOTS could yield very substantial public health and economic benefits for Ecuador. These results demonstrate the benefits from Canadian government support for DOTS implementation in low- and middle-income countries.
authors.affiliation: Respiratory Epidemiology & Clinical Research Unit, Montreal Chest Institute, McGill University, QC, Canada.
authors.forename: Olivia
authors.initials: O
authors.lastname: Oxlade
authors.forename: Judyth
authors.initials: J
authors.lastname: Vaca
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Romero
authors.forename: Kevin
authors.initials: K
authors.lastname: Schwartzman
authors.forename: Brian
authors.initials: B
authors.lastname: Graham
authors.forename: Lucero
authors.initials: L
authors.lastname: Hernandez
authors.forename: Terry
authors.initials: T
authors.lastname: Tannenbaum
authors.forename: Dick
authors.initials: D
authors.lastname: Menzies
mesh_terms: D002170:Canada; D003140:Communicable Disease Control / Q000191:economics*; D017046:Cost Savings; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D023801:Directly Observed Therapy / Q000191:economics*; D004484:Ecuador / Q000453:epidemiology; D005544:Forecasting; D006801:Humans; D008390:Markov Chains; D016730:Program Development; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D013997:Time Factors; D014376:Tuberculosis / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology / Q000401:mortality