Costs and Cost Effectiveness of Directly Observed Therapy Short-Course (DOTS) for Pulmonary Tuberculosis in Taiwan

Abstract

Objectives. The aim of the study was to explore the cost effectiveness of the Directly Observed Therapy Short-Course (DOTS) for pulmonary tuberculosis (TB) by community health workers in Taiwan.Methods. We analyzed TB cases treated in 2005 and in 2006 who had been followed up for 12 months from Taiwan's National TB computer registry database. The study further evaluated the cost effectiveness of the DOTS program by using decision analysis, and estimated the impact of DOTS program on a hypothetic TB cohort for 10 years and lifetime using Markov simulation model. Discount rate was introduced by 3 % and cost evaluation was adopted from societal perspectives.Results. Comparing the treatment outcome of infectious TB patients in 2005 and in 2006, the DOTS treatment success rate was higher than that of non-DOTS (80.26% vs 69.27%) and the mortality rate on DOTS was lower than that on non-DOTS (14.58% vs 26.44%). Moreover, DOTS strategy was more cost effective than non-DOTS strategy. The average cost-effectiveness ratio on DOTS strategy was calculated to be 111,991 NTD per treatment success, which is lower than 143,349 NTD per treatment success on non-DOTS. Based on hypothetic cohort of 5000 with infectious TB, implementing DOTS can increase treatment success by 550 persons and decrease deaths by 593. The use of DOTS can save 47,246,625.5 NTD a year. Markov simulation model displayed that the overall costs of implementing DOTS were lower than that of non-DOTS. Moreover, overall costs were progressively lowered by increasing participation rate in DOTS for 10, 20 and 30 years. Furthermore, the number of TB deaths after the implementation of a DOTS program was lower than that of a non-DOTS program. In addition, the number of TB treatments successes and remissions became higher as participation rate in DOTS increased for 10, 20 and 30 years.Conclusions. The DOTS program implemented in Taiwan seems cost effective.