Abstract
Objective: Brazil is one of the countries with the largest number of cases of tuberculosis worldwide; Rio de Janeiro exhibits some of highest mortality and incidence rates in the country. The aim of the present study was to perform a cost-effectiveness analysis of directly observed therapy (DOT) and simulate its expansion for new cases of pulmonary tuberculosis in Rio de Janeiro.Methods: A decision tree was plotted that simulated the progression of the disease for six months. In the cost-effectiveness analysis, strategies of self-administered treatment (SAT) and DOT (directly observed therapy) with 100% coverage were compared; the current coverage, 48%, and coverage of 100% were considered with regard to expansion. The study was based on the epidemiological pattern of tuberculosis in Rio de Janeiro among adults from both genders and without economic differences; the government perspective was adopted. The outcomes were varied to investigate the occurrence of parametric sensitivity.Results: Although the cost of treatment was increased by three times, DOT proved to be cost-effective for the treatment of new cases, with an incremental cost-effectiveness ratio (ICER) of BRL 30,454 per saved life. Expansion of DOT coverage would avert 180 deaths and 171 instances of treatment dropout, in addition to providing an additional 420 instances of cure, with an investment of approximately BRL 6,700,000.00.Conclusion: DOT might contribute to improving the current tuberculosis situation in the state of Rio de Janeiro. Its expansion would fit with the resources estimated by the Brazilian government needed to combat non-drug-resistant tuberculosis.
Highlights
Tuberculosis is a re-emerging disease that represents a serious public health problem
Simulation of directly observed therapy (DOT) for 100% of a cohort composed of 10,000 new cases of tuberculosis without drug resistance subjected to the six-month basic regimen resulted in 180 fewer deaths than that of self-administered treatment (SAT) and 22 fewer deaths than the current DOT coverage, 48%
The analysis performed showed that supervised therapy might be a cost-effective strategy for the treatment of new cases of pulmonary tuberculosis in the state of Rio de Janeiro
Summary
Tuberculosis is a re-emerging disease that represents a serious public health problem. Despite antibiotic therapy and the formulation of specific policies for treatment, control and prevention, tuberculosis was the main cause of death due to infectious diseases worldwide in 2014 [1]. Treatment dropout with consequent worsening of the disease is one of the main factors responsible for the current situation. To improve this condition, the tuberculosis control strategy recommended by the World Health Organization (WHO) is the directly observed therapy (DOT). In 2014, the coverage of DOT for new cases of tuberculosis in the state of Rio de Janeiro was 48% [6]; expansion of DOT coverage is expected to improve the disease indexes via an increase in the cure rate and a reduction of dropouts and deaths
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