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Free Content Directly observed treatment for multidrug-resistant tuberculosis: an economic evaluation in the United States of America and South Africa

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OBJECTIVE: To estimate the cost-effectiveness of directly observed treatment compared to conventional therapy in reducing the spread of multidrug-resistant tuberculosis, for an industrialised country (represented by the United States of America) and a developing country (South Africa).

METHODS: Monte Carlo analysis using published data on probability, cost and health impact.

RESULTS: In both countries, directly observed treatment is the dominant strategy, yielding cost savings and improved health outcomes. Cost savings for directly observed treatment relative to conventional therapy become more significant as more expensive second-line drugs are used in treatments.

CONCLUSIONS: The cost-effectiveness of directly observed treatment relative to conventional therapy is demonstrated for both the USA and South Africa. Cost savings are more pronounced (especially for South Africa) as the likelihood of multidrug-resistant tuberculosis increases and more expensive second-line therapies are used. Given that health care resources are more severely constrained in developing countries, the data contained in this study are useful in guiding the design of policies for the effective management of multidrug-resistant tuberculosis in settings with limited resources.
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Keywords: antimicrobial resistance; conventional therapy; cost-effectiveness analysis; directly observed therapy; multidrug-resistant tuberculosis; susceptible tuberculosis

Document Type: Regular Paper

Affiliations: 1: Health Economics Group, School of Health Policy and Practice, University of East Anglia, Norwich, UK 2: Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, UK 3: Department of Medical Microbiology, Barts & The London NHS Trust, Royal London Hospital, Whitechapel, London, United Kingdom

Publication date: 2001-12-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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