Abstract
BackgroundShortened 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.MethodsData 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).ResultsDuring 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.ConclusionIntroducing 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1269-x) contains supplementary material, which is available to authorized users.
Highlights
Shortened treatment regimens for tuberculosis are under development to improve treatment outcomes and reduce costs
Health service costs Service utilisation for TB is presented by facility in Additional file 1: Table S1 in the supplementary material
We present a comprehensive cost study describing detailed information on first-line regimen costs that can serve as an input for decision-making and budget preparation for National TB Programmes (NTP) when considering the introduction of new shortened regimens
Summary
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. Introducing a 4-month regimen for TB in a high service cost scenario, such as Brazil, may lead to overall savings from the health service perceptive [16]. Previous studies suggest that cost savings from the patient side may be an important advantage of shortened TB regimens. The purpose of this study is to assess health service and patient costs during the last two months of the current first-line regimen and to explore potential savings following the introduction of a 4-month regimen in Rio de Janeiro, Brazil
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