REVIEW OF PUBLISHED COST-EFFECTIVENESS STUDIES ON TUBERCULOSIS TREATMENT PROGRAMS

This article aims to summarise key factors in the published literature associated with cost-effective tuberculosis (TB) treatment programmes and to make recommendations on how techniques for future studies coul d be improved. There is consistent evidence that fully ambulatory, sho rt course chemotherapy programmes are currently the most cost-effectiv e option, although this may depend on the cost of providing an effecti ve community-based service. Direct supervision may be more cost-effect ive than self-administration because of the reduced need for monitorin g and follow-up; more studies are needed, however, that include real o utcome figures and household measures of cost. For studies taking a pr ovider perspective, the methods used for measuring costs will be depen dent on sources of information, but centralised accounts are the most preferred source. Effects should be measured in terms of actual outcom e, and should preferably not be taken from the literature. Most of the studies reviewed did not consider the difficulties of introducing a t heoretically cost-effective change into a health service. More studies are required that document actual changes in programme cost and outco me associated with the introduction of different types of treatment de livery. Future work could consider measuring cost in terms of resource s (e.g., staff) rather than only finances, and more work is needed on household perspectives.