title: Cost-effectiveness of a comprehensive programme for drug-resistant tuberculosis in China.
abstract: OBJECTIVE
  To investigate the cost-effectiveness of a comprehensive programme for drug-resistant tuberculosis launched in four sites in China in 2011.
  
  
  METHODS
  In 2011-2012, we reviewed the records of 172 patients with drug-resistant tuberculosis who enrolled in the comprehensive programme and we collected relevant administrative data from hospitals and China's public health agency. For comparison, we examined a cohort of 81 patients who were treated for drug-resistant tuberculosis in 2006-2009. We performed a cost-effectiveness analysis, from a societal perspective, that included probabilistic uncertainty. We measured early treatment outcomes based on three-month culture results and modelled longer-term outcomes to facilitate estimation of the comprehensive programme's cost per disability-adjusted life-year (DALY) averted.
  
  
  RESULTS
  The comprehensive programme cost 8837 United States dollars (US$) per patient treated. Low enrolment rates meant that some fixed costs were higher, per patient, than expected. Although the comprehensive programme appeared 30 times more costly than the previous one, it resulted in greater health benefits. The comprehensive programme, which cost US$ 639 (95% credible interval: 112 to 1322) per DALY averted, satisfied the World Health Organization's criterion for a very cost-effective intervention.
  
  
  CONCLUSIONS
  The comprehensive programme, which included rapid screening, standardized care and financial protection, improved individual outcomes for MDR tuberculosis in a cost-effective manner. To support post-2015 global heath targets, the comprehensive programme should be expanded to non-residents and other areas of China.
authors.affiliation: World Health Organization, Geneva, Switzerland .
authors.forename: Christopher
authors.initials: C
authors.lastname: Fitzpatrick
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Zhang
authors.initials: Z
authors.lastname: Hui
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Wang
authors.initials: W
authors.lastname: Lixia
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Li
authors.initials: L
authors.lastname: Renzhong
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Ruan
authors.initials: R
authors.lastname: Yunzhou
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Chen
authors.initials: C
authors.lastname: Mingting
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Zhao
authors.initials: Z
authors.lastname: Yanlin
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Zhao
authors.initials: Z
authors.lastname: Jin
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Su
authors.initials: S
authors.lastname: Wei
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Xu
authors.initials: X
authors.lastname: Caihong
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Chen
authors.initials: C
authors.lastname: Cheng
authors.affiliation: World Health Organization, Geneva, Switzerland .
authors.forename: Timothy
authors.initials: T
authors.lastname: Alston
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Qu
authors.initials: Q
authors.lastname: Yan
authors.affiliation: Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, No 44 Wenhua Rd, Mailbox 128, Jinan, Shandong 250012, China .
authors.forename: Lv
authors.initials: L
authors.lastname: Chengfei
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China .
authors.forename: Fu
authors.initials: F
authors.lastname: Yunting
authors.affiliation: Bill & Melinda Gates Foundation, Beijing, China .
authors.forename: Huan
authors.initials: H
authors.lastname: Shitong
authors.affiliation: Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, No 44 Wenhua Rd, Mailbox 128, Jinan, Shandong 250012, China .
authors.forename: Sun
authors.initials: S
authors.lastname: Qiang
authors.affiliation: World Health Organization, Beijing, China .
authors.forename: Fabio
authors.initials: F
authors.lastname: Scano
authors.affiliation: Bill & Melinda Gates Foundation, Beijing, China .
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Chin
authors.affiliation: World Health Organization, Geneva, Switzerland .
authors.forename: Katherine
authors.initials: K
authors.lastname: Floyd
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006293:Health Promotion / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D019057:Quality-Adjusted Life Years; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D055815:Young Adult