Directly observed therapy-short course (DOTS) in Taiwan---economic evaluation
Date Issued
2008
Date
2008
Author(s)
Chung, Wei-Sheng
Abstract
Mycobacterium tuberculosis not only infects human being but also causes morbidity and mortality. People who contract tuberculosis should take antituberculosis medicine for at least 6 months. During treatment, these patients may suffer from side effects of the drugs and also incur social stigma. Moreover, pulmonary tuberculosis (TB) could increase the social cost of the patients, their families, healthcare units and the society. Multi-drug resistance TB may result from those who did not follow regular treatment. Therefore, TB becomes one of the important issues of public health, social, and economic problems in the world. Directly observed therapy short-course (DOTS) had been launched in Taiwan since 2006. The government expected to increase the treatment success rate and decrease the incidence rate by investing human resources and financial support. Exisiting studies of TB were mostly focused on the treatment outcome in lack of economic evaluation. Therefore, the aims of the study were to investigate the effect of DOTS on the treatment outcome (treatment success and TB death), to evaluate the economic impact of the DOTS by using decision tree, and to estimate the impact of DOTS on the TB cohort for 10 years and lifetime by using the Markov model. Discount rate was introduced by 3 % and cost evaluation was adopted from social perspectives The result of the study displayed that after adjusting other variables, the probability of treatment success in DOTS group was 2.84 times higher than that of self administered therapy (non-DOTS) group. The death probability of self administered therapy group was 2.78 times higher than that of DOTS group. Cost effectiveness ratio revealed that 111,991 NTD on DOTS group, which was better than self administered therapy group (143,349 NTD). arkov model displayed that the total cost of DOTS implementation was lower than that of self administered therapy group. Moreover, total cost was progressively lower in accordance with increasing participating in DOTS rate for 10 years, 20 years and 30 years as well. Total effect of DOTS implementation was higher than that of self administered therapy. Besides, total effect became higher in accordance with increasing participating in DOTS rate for 10 years, 20 years and 30 years as well. Furthermore, the numbers of TB cases and TB death after DOTS implementation were lower than that of self administered therapy. In addition, the numbers of TB cases and TB death became lower in accordance with increasing participating in DOTS rate for 10 years, 20 years and 30 years as well. o bring into force of DOTS, training of the healthcare workers and providing nutritional incentives for TB patients, DOTS program must deliver enough doses of medications to patients to ensure compliance. Despite that DOTS program increased the expense at the onset, but it is cost effectiveness in the long run. One of the major benefits of effective treatment of active TB is the prevention of further transmission and decreasing the drug resistance TB emergence. he study could not evaluate the cost of the drug interaction and side effects on treatment of TB and co-morbidities, which might be our limitation. The study also could not evaluate psychological costs of social stigmatization and ostracism which might be another limitation. In conclusion, the DOTS program implemented in Taiwan was a cost effectiveness program.
Subjects
pulmonary tuberculosis
directly observed therapy short-course
treatment success
cost effectiveness analysis
Markov model
SDGs
Type
thesis
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