title: Shortened first-line TB treatment in Brazil: potential cost savings for patients and health services.
abstract: BACKGROUND
  Shortened treatment regimens for tuberculosis are under development to improve treatment outcomes and reduce costs. We estimated potential savings from a societal perspective in Brazil following the introduction of a hypothetical four-month regimen for tuberculosis treatment.
  
  
  METHODS
  Data were gathered in ten randomly selected health facilities in Rio de Janeiro. Health service costs were estimated using an ingredient approach. Patient costs were estimated from a questionnaire administered to 126 patients. Costs per visits and per case treated were analysed according to the type of therapy: self-administered treatment (SAT), community- and facility-directly observed treatment (community-DOT, facility-DOT).
  
  
  RESULTS
  During the last 2 months of treatment, the largest savings could be expected for community-DOT; on average USD 17,351-18,203 and USD 43,660-45,856 (bottom-up and top-down estimates) per clinic. Savings to patients could also be expected as the median (interquartile range) patient-related costs during the two last months were USD 108 (13-291), USD 93 (36-239) and USD 11 (7-126), respectively for SAT, facility-DOT and community-DOT.
  
  
  CONCLUSIONS
  Introducing a four-month regimen may result in significant cost savings for both the health service and patients, especially the poorest. In particular, a community-DOT strategy, including treatment at home, could maximise health services savings while limiting patient costs. Our cost estimates are likely to be conservative because a 4-month regimen could hypothetically increase the proportion of patients cured by reducing the number of patients defaulting and we did not include the possible cost benefits from the subsequent prevention of costs due to downstream transmission averted and rapid clinical improvement with less side effects in the last two months.
authors.affiliation: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. atrajman@gmail.com.|McGill University, Montreal, Canada. atrajman@gmail.com.|Tuberculosis Scientific League, Rio de Janeiro, Brazil. atrajman@gmail.com.
authors.forename: Anete
authors.initials: A
authors.lastname: Trajman
authors.affiliation: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.|Tuberculosis Scientific League, Rio de Janeiro, Brazil.
authors.forename: Mayara Lisboa
authors.initials: ML
authors.lastname: Bastos
authors.affiliation: Tuberculosis Scientific League, Rio de Janeiro, Brazil.|Souza Marques Foundation, Rio de Janeiro, Brazil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Belo
authors.affiliation: Tuberculosis Scientific League, Rio de Janeiro, Brazil.
authors.forename: Janaína
authors.initials: J
authors.lastname: Calaça
authors.affiliation: Tuberculosis Scientific League, Rio de Janeiro, Brazil.
authors.forename: Júlia
authors.initials: J
authors.lastname: Gaspar
authors.affiliation: Tuberculosis Scientific League, Rio de Janeiro, Brazil.
authors.forename: Alexandre Martins
authors.initials: AM
authors.lastname: Dos Santos
authors.affiliation: Tuberculosis Scientific League, Rio de Janeiro, Brazil.
authors.forename: Camila Martins
authors.initials: CM
authors.lastname: Dos Santos
authors.affiliation: Rio de Janeiro Municipal Health Department, Rio de Janeiro, Brazil.
authors.forename: Raquel Trindade
authors.initials: RT
authors.lastname: Brito
authors.affiliation: Global Alliance for TB Drug Development, New York, USA.|Current address: United States Agency for International Development, Washington, DC, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Wells
authors.affiliation: Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Cobelens
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
authors.affiliation: Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.|Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Gabriela B
authors.initials: GB
authors.lastname: Gomez
mesh_terms: D000328:Adult; D001938:Brazil; D017046:Cost Savings / Q000191:economics*; D003362:Cost-Benefit Analysis; D023801:Directly Observed Therapy; D005260:Female; D005382:Financing, Personal; D006296:Health Services / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*