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Nationwide Economic Analysis of Pulmonary Tuberculosis in Brazil Over Seven Years: Prioritizing Vulnerable Populations for Enhanced Treatment Strategies
34 Pages Posted: 18 Jan 2024
More...Abstract
Background: Tuberculosis (TB) remains a challenge to global public health, disproportionately affecting vulnerable populations in low- and middle-income countries. This study extensively analyses the economic burden of pulmonary TB (PTB) in Brazil, focusing on direct healthcare costs. It also evaluates the cost-effectiveness of the Directly Observed Treatment (DOT) strategy and the economic effort required to achieve a 90% probability of cure.
Methods A nationwide retrospective study utilized data from the Brazilian Information System for Notifiable Diseases (SINAN-TB) between 2015 and 2022. The cost per PTB case was estimated, encompassing expenses related to healthcare professionals, medication, laboratory exams, and the duration of treatment reported in SINAN. Medication costs were determined based on the National Health Surveillance Agency (ANVISA) cost table. Human resource expenses considered family physician consultations and health agent home visits for DOT, while laboratory examination costs were derived from government-provided values for public health services. The population was stratified based on the presence of social vulnerabilities or a history of previous anti-TB treatment (ATT). Number Needed to Treat (NNT) analyses assessed the effectiveness of DOT implementation at different settings. Additionally, the study calculated the cost needed to achieve a 90% probability of cure through binomial regression models.
Findings: The total direct cost for PTB in Brazil during the seven years exceeded $108 million, with retreatment cases accounting for $19.8 million. NNT analyses highlighted retreatment, homeless, and Persons Using Drugs (PUD) subpopulations as the most effective for DOT implementation. The cost to achieve a 90% probability of cure was higher in the retreatment group, as well as in homeless and PUD populations. Notably, overlaying retreatment history with social vulnerabilities increased the associated cost.
Interpretation: This study exposes the substantial economic burden of PTB in Brazil, emphasizing the necessity for tailored strategies, particularly for vulnerable populations and those with a history of ATT. The findings highlight the crucial role of DOT in improving ATT outcomes despite the higher cost, especially in specific subgroups. More cost-effective interventions and target population approaches are still needed to optimize TB control efforts.
Funding: Intramural Research Program of the Oswaldo Cruz Foundation.
Declaration of Interest: None to declare.
Ethical Approval: All data analysed in this study were obtained from a public government program (SINAN-TB) and were pre-processed by the Brazilian Ministry of Health (https://datasus.saude.gov.br/informacoes-de-saude-tabnet/). The datasets were verified by eliminating duplicate registrations and ensuring consistency and completeness of registered data, following the regulations dictated by Resolution No. 466/12 on Research Ethics of the National Health Council, Brazil. This study did not require written informed consent for participation under national legislation and institutional requirements.
Keywords: Tuberculosis, cost, retreatment, vulnerable populations, direct observed treatment, treatment outcome
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