Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti.
BACKGROUND
Implementation of the World Health Organization's DOTS strategy (Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives.


METHODS
Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$.


RESULTS
Starting in 2003, DOTS expansion in Haiti is anticipated to cost $4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion.


CONCLUSIONS
A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.
Jacquet
Vary
V
National tuberculosis control programme, Port-au-Prince, Haiti. varyj@yahoo.com
Morose
Willy
W
Schwartzman
Kevin
K
Oxlade
Olivia
O
Barr
Graham
G
Grimard
Franque
F
Menzies
Dick
D
D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000191:economics; D017281:Cost of Illness; D023801:Directly Observed Therapy / Q000191:economics*; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage / Q000191:economics; D006205:Haiti / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage / Q000191:economics; D015397:Program Evaluation; D011718:Pyrazinamide / Q000008:administration & dosage / Q000191:economics; D012293:Rifampin / Q000008:administration & dosage / Q000191:economics; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D014944:World Health Organization
D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin