Feasibility and cost-effectiveness of treating multidrug-resistant tuberculosis: a cohort study in the Philippines.
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) is an important global health problem, and a control strategy known as DOTS-Plus has existed since 1999. However, evidence regarding the feasibility, effectiveness, cost, and cost-effectiveness of DOTS-Plus is still limited.


RESULTS
We evaluated the feasibility, effectiveness, cost, and cost-effectiveness of a DOTS-Plus pilot project established at Makati Medical Center in Manila, the Philippines, in 1999. Patients with MDR-TB are treated with regimens, including first- and second-line drugs, tailored to their drug susceptibility pattern (i.e., individualised treatment). We considered the cohort enrolled between April 1999 and March 2002. During this three-year period, 118 patients were enrolled in the project; 117 were considered in the analysis. Seventy-one patients (61%) were cured, 12 (10%) failed treatment, 18 (15%) died, and 16 (14%) defaulted. The average cost per patient treated was US3,355 dollars from the perspective of the health system, of which US1,557 dollars was for drugs, and US837 dollars from the perspective of patients. The mean cost per disability-adjusted life year (DALY) gained by the DOTS-Plus project was US242 dollars (range US85 dollars to US426 dollars).


CONCLUSIONS
Treatment of patients with MDR-TB using the DOTS-Plus strategy and individualised drug regimens can be feasible, comparatively effective, and cost-effective in low- and middle-income countries.
Tupasi
Thelma E
TE
Tropical Disease Foundation, Manila, Philippines.
Gupta
Rajesh
R
Quelapio
Ma Imelda D
MI
Orillaza
Ruth B
RB
Mira
Nona Rachel
NR
Mangubat
Nellie V
NV
Belen
Virgil
V
Arnisto
Nida
N
Macalintal
Lualhati
L
Arabit
Michael
M
Lagahid
Jaime Y
JY
Espinal
Marcos
M
Floyd
Katherine
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D023801:Directly Observed Therapy / Q000191:economics*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010679:Philippines / Q000453:epidemiology; D012189:Retrospective Studies; D018088:Tuberculosis, Multidrug-Resistant / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*
D000995:Antitubercular Agents