Pharma Focus Asia

Feasibility and Cost-Effectiveness of Treating Multidrug-Resistant Tuberculosis: A Cohort Study in the Philippines

Thelma E. Tupasi1, Rajesh Gupta2,3, Ma Imelda D. Quelapio1, Ruth B. Orillaza1, Nona Rachel Mira1, Nellie V. Mangubat1, Virgil Belen1, Nida Arnisto1, Lualhati Macalintal1, Michael Arabit1, Jaime Y. Lagahid4, Marcos Espinal2, Katherine Floyd2*

Thelma E. Tupasi1, Rajesh Gupta2,3, Ma Imelda D. Quelapio1, Ruth B. Orillaza1, Nona Rachel Mira1, Nellie V. Mangubat1, Virgil Belen1, Nida Arnisto1, Lualhati Macalintal1, Michael Arabit1, Jaime Y. Lagahid4, Marcos Espinal2, Katherine Floyd2*

1 Tropical Disease Foundation, Manila, Philippines, 2 Stop TB Department, World Health Organization, Geneva, Switzerland, 3 Stanford University School of Medicine, Stanford, California, United States of America, 4 Infectious Disease Office, National Center for Disease Prevention and Control, Department of Health, Manila, Philippines

Background

Multidrug-resistant tuberculosis (MDR-TB) is an important global health problem, and a control strategy known as DOTS-Plus has existed since 1999. However, evidence regarding the feasibility, effectiveness, cost, and cost-effectiveness of DOTS-Plus is still limited.

Methodology/Principal Findings

We evaluated the feasibility, effectiveness, cost, and cost-effectiveness of a DOTS-Plus pilot project established at Makati Medical Center in Manila, the Philippines, in 1999. Patients with MDR-TB are treated with regimens, including first- and second-line drugs, tailored to their drug susceptibility pattern (i.e., individualised treatment). We considered the cohort enrolled between April 1999 and March 2002. During this three-year period, 118 patients were enrolled in the project; 117 were considered in the analysis. Seventy-one patients (61%) were cured, 12 (10%) failed treatment, 18 (15%) died, and 16 (14%) defaulted. The average cost per patient treated was US$3,355 from the perspective of the health system, of which US$1,557 was for drugs, and US$837 from the perspective of patients. The mean cost per disability-adjusted life year (DALY) gained by the DOTS-Plus project was US$242 (range US$85 to US$426).

Conclusions

Treatment of patients with MDR-TB using the DOTS-Plus strategy and individualised drug regimens can be feasible, comparatively effective, and cost-effective in low- and middle-income countries.

Funding: The study was partly supported by grants provided to the World Health Organization by the United States Agency for International Development and the Bill and Melinda Gates Foundation, and a grant from the Special Programme for Training and Research in Tropical Diseases. Funds for second line anti-TB drugs were provided by the Philippines Department of Health, the Philippines Charity Sweepstakes Office, United Laboratories, Barangay San Lorenzo, and friends of the Tropical Disease Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests : None of the authors have any financial or personal relationship with people or organizations who could inappropriately bias the study. The corresponding author had full access to all the data collected for the study.

Academic Editor:Philip Hopewell, University of California San Francisco, United States of America
Received: November 14, 2005; Accepted: June 2, 2006; Published: September 12, 2006

DOI: 10.1371/journal.pmed.0030352

Copyright:© 2006 Tupasi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abbreviations: DALY, disability-adjusted life year; GLC, Green Light Committee; MDR-TB, multidrug-resistant tuberculosis; MMC, Makati Medical Center; TB, tuberculosis, WHO, World Health Organization.

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