COST-EFFECTIVENESS ANALYSIS OF DIRECTLY OBSERVED THERAPY FOR TUBERCULOSIS AND ITS EXPANSION IN RIO DE JANEIRO
DOI:
https://doi.org/10.22159/ijpps.2017v9i10.21099Keywords:
Tuberculosis, Directly Observed Therapy, DOT, Cost-Effectiveness Analysis, Healthcare AssessmentAbstract
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.Â
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References
World Health Organization. Global tuberculosis report; 2016. Geneva: World Health Organization. Available from: http://www.who.int./tb/publications/global_report/gtbr2016. [Last accessed on 29 Jul 2017]
Brasil. Ministerio da Saude. Situaçao Epidemiologica. Dados da tuberculose. Available from: http://portalsaude.saude.gov.br/index.php/o-inisterio/principal/leia-59 mais-o-ministerio/741-secretaria-svs/vigilancia-de-a-a-z/tuberculose/11485-situacao-epidemiologica-dados. [Last accessed on 14 Jan 2017]
Minnesota Department of Health. TB Prevention and Control Program. Available from: http://www.health.state.mn.us/ divs/idepc/diseases/tb/lph/dot.html. [Last accessed on 30 Jun 2017]
Khairunnisa AN. Pharmacists’ perception about their roles in tuberculosis control program in medan, Indonesia. Asian J Pharm Clin 2017;10:256-8.
McLaren ZM, Meyer AJ, Sharp AR. Does directly observed therapy improve tuberculosis treatment? More evidence is needed to guide tuberculosis policy. BMC Infect Dis 2016;16:537.
Brasil. Ministerio da Saude. Sistema de informaçao de agravos de notificacao. Available from: http://sistemas.saude. rj.gov.br/tabnet/deftohtm.exe?sinan/tuberculose.def/. [Last accessed on 10 Feb 2017]
Khan MA, Walley JD, Witter SN, Imran A, Safdar N. Costs and cost-effectiveness of different DOT strategies for the treatment of tuberculosis in Pakistan. Health Policy Plan 2002;17 :178-86.
Data version, 1.0.3. Tree Age Software, Inc., Williamstown; 2009.
Ferreira V, Brito C, Portela M, Escosteguy C, Lima S. DOTS in primary care units in the city of rio de janeiro, Southeastern Brazil. Rev Saude Publica 2011;45:40-8.
Steffen R, Menzies D, Oxlade O, Pinto M, de Castro AZ, Monteiro P, et al. Patients' costs and cost-effectiveness of tuberculosis treatment in DOTS and non-DOTS facilities in Rio de Janeiro, Brazil. PLoS One 2010;5:e14014.
Brasil. Ministerio da saude. Secretaria de vigilancia em saude. Departamento de vigilancia epidemiologica. Manual de recomendacoes para o controle da tuberculose no Brasil. Brasilia: Ministerio da Saude 2011. p. 284.
Brasil. Ministerio da saude. Informações sobre tuberculose no Brasil. Available from: http://www.acessoainformacao.gov.br. [Last accessed on 10 Feb 2017]
Brasil. Ministerio da Saude. Sistema de gerenciamento da tabela de procedimentos, medicamentos e OPM do SUS. Available from: http://sigtap.datasus.gov.br/tabela-unificada/ app/sec/inicio.jsp. [Last accessed on 06 Mar 2017]
Mohan CI, Bishai D, Cavalcante S, Chaisson RE. The cost-effectiveness of DOTS in urban Brazil. Int J Tuberc Lung Dis 2007;11: 27-32.
Rio de Janeiro. Decreto n °31.261 de 14 de outubro de 2009. Dispoe para o exercicio de 2009, sobre o reajuste anual da remuneracao. Diario oficial do municipio do rio de janeiro. Poder Executivo. Ano XXIII 2009;143:3-15.
Rio de Janeiro. Decreto n °32.501 de 7 de julho de 2010. Dispõe sobre o reajuste anual dos servidores municipais, nos termos que menciona. Diário Oficial do MunicÃpio do Rio de Janeiro. Poder Executivo. Ano XXIV 2010;75:3.
Rio de Janeiro. Decreto n °34.015 de 21 de junho de 2011. Dispoe sobre o reajuste anual dos servidores municipais, nos termos que menciona. Diario oficial do municipio do rio de janeiro. Poder Executivo. Ano XXV 2011;70:3.
Rio de Janeiro. Decreto n °35.806 de 22 de junho de2012. Dispoe sobre o reajuste anual dos servidores municipais, nos termos que menciona. Diario Oficial do Municipio do Rio de Janeiro. Poder Executivo. Ano XXVI. 2012;66:3.
Rio de Janeiro. Decreto n °37.459 de 29 de julho de 2013. Dispoe sobre o reajuste anual dos servidores municipais, nos termos que menciona. Diário Oficial do MunicÃpio do Rio de Janeiro. Poder Executivo. Ano XXVII. 2013;91:3.
Rio de Janeiro. Decreto n °38.878 de 2 de julho de 2014. Dispoe sobre o reajuste anual dos servidores municipais, nos termos que menciona. Diario Oficial do MunicÃpio do Rio de Janeiro. Poder Executivo. Ano XXVIII. 2014;73:3.
Oxlade O, Vaca J, Romero E, Schwartzman K, Graham B, Hernandez L, et al. The long-term health and economic benefits of DOTS implementation in Ecuador. Can J Public Health 2006;97:14-9.
Jacquet V, Morose W, Schwartzman K, Oxlade O, Barr G, Grimard F, et al. Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti. BMC Public Health 2006;6:209.
da Paz, LNF, de Oliveira Ohnishi MD, Barbagelata CM, et de Arruda Bastos F. Efetividade do tratamento da tuberculose. J Bras Pneumol 2012;38: 503-10.
Brasil. Ministério da Saude, Secretaria de Politicas de Saude, Departamento de Atencao Basica. Manual tecnico para o controle da tuberculose: cadernos de atencao basica. Ministerio da saude, secretaria de politicas de saude, departamento de atencao basica. 6 ed. Rev e ampl. Brasilia: Ministerio da Saude; 2002. p. 62. Available from: http://bvsms.saude.gov.br/ bvs/publicacoes/guia_controle_tuberculose.pdf. [Last accessed on 15 Jun 2017].
Suarez PG, Watt CJ, Alarcon E, Portocarrero J, Zavala D, Canales R, et al. The dynamics of tuberculosis in response to 10 y of intensive control effort in Peru. J Infect Dis 2001;184:473-8.
Chrispim PPM. Uma contribuicao para a discussao sobre avaliacaes de programas de controle da tuberculose. Tese (Doutorado em Ciencias na area de saude Pública) Fundacao Oswaldo Cruz. Escola Nacional de Saude Publica Sergio Arouca. Rio de Janeiro; 2011. p. 138.
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