Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti
Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti
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DOI：
10.1186/1471-2458-6-209
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发表时间：
2006-08-15
影响因子：
4.5
通讯作者：
Menzies, Dick
中科院分区：
文献类型：
--
作者：
Jacquet, Vary;Morose, Willy;Menzies, Dick
背景资料：实施世界卫生组织的DOTS战略（直接观察治疗短期疗法）可以大大减少结核病的发病率。我们估计潜在的成本和效益的DOTS扩展在海地从政府和社会的perspectives.Methods：使用决策分析，将多个马尔可夫过程（马尔可夫模型），我们比较了预期的结核病发病率，死亡率和成本在海地DOTS扩展到全国各地，并实现世界卫生组织的基准，或者如果目前的情况没有改变。结核病相关结局的概率来自已发表的文献。政府的卫生支出，病人和家庭的成本进行了衡量，在海地的直接调查，并表示在2003年US$.Results：从2003年开始，DOTS在海地的扩展预计将花费420万美元，并导致63 080例减少肺结核病例，53 120例减少肺结核死亡，净社会储蓄1.31亿美元，超过20年。目前政府对结核病的支出相对于人均收入来说是很高的，如果有DOTS，只会略低。社会储蓄将在4年内开始，并将在所有情况下考虑，包括更高的艾滋病毒血清阳性率或耐药性，不变的发病率DOTS扩展后，或初始和持续成本增加一倍DOTS expansion.Conclusion：适度投资DOTS扩展在海地将提供相当大的人道主义利益，减少结核病相关的发病率，死亡率和患者及其家属的费用。这些好处，再加上预计海地政府的最低储蓄，有力地证明了捐助者对DOTS扩展的支持。
Background: Implementation of the World Health Organization's DOTS strategy ( Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives.Methods: Using decision analysis incorporating multiple Markov processes ( Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$.Results: Starting in 2003, DOTS expansion in Haiti is anticipated to cost $4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion.Conclusion: A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.