Cost effectiveness analysis of directly observed therapy, short course management, for pulmonary tuberculosis in Mongolia

Abstract

Objectives: To evaluate and compare the cost and treatment outcomes associated with different directly observed treatment, short course (DOTS) strategies in Mongolia as of 2010. New cases of smear – positive pulmonary tuberculosis cohorts were enrolled. Methods: Tuberculosis (TB) control strategy, supervised by government financed tuberculosis dispensary (TB center), was compared with volunteer - based DOTS program from Mongolian Anti-Tuberculosis Association (MATA). Cost effectiveness analysis was undertaken by using conventional method of computation by Microsoft Excel. Decision tree model was used per successfully treated case. Costs (US dollars as of 2010) were calculated on the basis of treatment periods and treatment outcomes. Treatment outcomes were estimated for the period of one year of sputum smear- positive pulmonary tuberculosis patients with cured and successfully treated cases on the basis of Mongolian evidence for the efficacy of the chosen strategies. Results: Cost effectiveness ratio (CER) presents the preference for DOTS with MATA volunteers over the Dispensary program. The uncertainty ranges surrounding health effects were significantly different, with ample probability that DOTS program with MATA volunteers could lead to more curable outcomes than dispensaries. Cost effectiveness per successful treatment was US$ 954.90 for Dispensary program, while it was US$ 809.48 for MATA program. Cost savings from less failed and defaulted treatment were revealed in relation to DOTS with MATA volunteers. After running the sensitivity analysis by decreasing default rate for dispensary program to the equal rate of DOTS with MATA volunteers, CER of Dispensary DOTS was improved but has not reached to MATA program. High cost of inpatient clinic in rural areas is one of the determining factors for the high cost of DOTS program. However, decreasing cost of inpatient clinic by downsizing inpatient stay, MATA program has shown to be more sensitive and to be even more cost effective intervention. Conclusions: Due to high rates of failed and defaulted cases, and high travel cost among beneficiaries from dispensary DOTS, volunteer based MATA program demonstrates more cost effective approach. It is decisive that DOTS with MATA volunteers is a cost - saving intervention in Mongolia.