COST-EFFECTIVENESS OF ANTITUBERCULOSIS INTERVENTIONS

The treatment of tuberculosis (TB) is ranked as the most cost effectiv e of all therapeutic programmes in terms of cost per year of life save d. Nevertheless, TB kills or debilitates more adults aged between 15 a nd 59 years than any other disease in the world; furthermore, about 2 to 4% of the burden of disease, 7% of all deaths and 26% of all preven table deaths are directly attributable to TB. About one-third of the w orld's population is infected with the TB bacillus. In the developing world, more women of childbearing age die from TB than from causes dir ectly associated with pregnancy and childbirth. The death of adults in their prime, who are parents, community leaders and producers in most societies, causes a particularly onerous burden besides being a serio us public health problem. In the poorest countries, where the magnitud e of the TB problem is greatest, those TB control strategies that are economically feasible tend to be less effective. Therefore, in low and middle income countries, cost-effectiveness considerations aimed at p rioritising resource allocation in the health sector in general, and i n TB control programmes in particular, are of paramount importance. Op erationally, the main components of a TB control programme are: (i) de tection and treatment of TB; and (ii) prevention of TB through BCG vac cination and chemoprophylaxis. Priority should be given to ensuring th at TB patients complete their prescribed course of chemotherapy. Adequ ate treatment is the most effective way of preventing the spread of TB and the emergence of drug resistance. This article reviews evidence o f the effectiveness and cost effectiveness of different approaches to TB can, particularly those that are applicable to low income countries , in both HIV-infected and noninfected patients. Financial implication s and ways to implement directly observed therapy for TB in large urba n areas are discussed, and the need to address some relevant operation al issues is highlighted. The current role of chemoprophylaxis and BCG vaccination is also reviewed.