The long-term health and economic benefits of DOTS implementation in Ecuador.
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.
Oxlade
Olivia
O
Respiratory Epidemiology & Clinical Research Unit, Montreal Chest Institute, McGill University, QC, Canada.
Vaca
Judyth
J
Romero
Elizabeth
E
Schwartzman
Kevin
K
Graham
Brian
B
Hernandez
Lucero
L
Tannenbaum
Terry
T
Menzies
Dick
D
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