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Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti

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 pe...

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Autores principales: Jacquet, Vary, Morose, Willy, Schwartzman, Kevin, Oxlade, Olivia, Barr, Graham, Grimard, Franque, Menzies, Dick
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2006
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1590025/
https://www.ncbi.nlm.nih.gov/pubmed/16911786
http://dx.doi.org/10.1186/1471-2458-6-209
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author Jacquet, Vary
Morose, Willy
Schwartzman, Kevin
Oxlade, Olivia
Barr, Graham
Grimard, Franque
Menzies, Dick
author_facet Jacquet, Vary
Morose, Willy
Schwartzman, Kevin
Oxlade, Olivia
Barr, Graham
Grimard, Franque
Menzies, Dick
author_sort Jacquet, Vary
collection PubMed
description 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 $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion. CONCLUSION: A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.
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spelling pubmed-15900252006-10-05 Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti Jacquet, Vary Morose, Willy Schwartzman, Kevin Oxlade, Olivia Barr, Graham Grimard, Franque Menzies, Dick BMC Public Health Research Article BACKGROUND: Implementation of the World Health Organization's DOTS strategy (Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives. METHODS: Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$. 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. BioMed Central 2006-08-15 /pmc/articles/PMC1590025/ /pubmed/16911786 http://dx.doi.org/10.1186/1471-2458-6-209 Text en Copyright © 2006 Jacquet et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Jacquet, Vary
Morose, Willy
Schwartzman, Kevin
Oxlade, Olivia
Barr, Graham
Grimard, Franque
Menzies, Dick
Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti
title Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti
title_full Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti
title_fullStr Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti
title_full_unstemmed Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti
title_short Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti
title_sort impact of dots expansion on tuberculosis related outcomes and costs in haiti
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1590025/
https://www.ncbi.nlm.nih.gov/pubmed/16911786
http://dx.doi.org/10.1186/1471-2458-6-209
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