Cost-effectiveness analysis of tuberculosis control policies in Ivanovo Oblast, Russian Federation

Many of the current tuberculosis control programmes in the Russian Federati on are based on costly strategies which are underfunded and use long, indiv idualized treatment regimens. This article compares, using a cost-effective ness analysis, the new WHO strategy implemented in the Ivanovo Oblast (case -finding among symptomatic patients (SCF) and shorter regimens) and the old strategy (active screening of the asymptomatic population (ACF) and longer regimens). The cost per case cured was calculated at different levels of cure rate (45 -95%) using three scenarios to describe the new WHO strategy (use of WHO-re commended regimens and three options at increasing rates of admission) and a fourth scenario to describe the old strategy tall patients admitted for t he whole treatment and longer regimens). The cost per case detected was det ermined by calculating the following: yield of the new and old strategy (nu mber of examinations necessary to diagnose one case); cost of the diagnosti c process; multiplying yield per cost according to the three scenarios desc ribing the new WHO strategy and a fourth scenario describing the old strate gy. In the Ivanovo Oblast the cost per case cured, at 85% cure rate level, rang ed from US% 1197 (new strategy, scenario I without food) to US$ 6293 told s trategy, scenario 4) the cost per case detected ranged from US$ 1581 (new s trategy, scenario I) to US$ 4000 told strategy scenario 4). Significant sav ings can result from shifting towards the new WHO strategy. Decision-makers and health administrators should be responsible for re-investing the finan cial and human resources mobilized by the adoption of cost-effective strate gies within the TB control programme.