Freeman Spogli Institute for International Studies Program on Energy and Sustainable Development Stanford University


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

Journal Article

Thelma E. Tupasi, Rajesh Gupta, Ma Imelda D. Quelapio, Ruth B. Orillaza, Nona Rachel Mira, Nellie V. Mangubat, Virgil Belen, Nida Arnisto, Lualhati Macalintal, Michael Arabit, Jaime Y. Lagahid, Marcos Espinal, Katherine Floyd

Published by
PLoS Medicine, Vol. 3 no. 9
September 2006

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).

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.