Elsevier

The Lancet

Volume 338, Issue 8778, 23 November 1991, Pages 1305-1308
The Lancet

PUBLIC HEALTH
Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries

https://doi.org/10.1016/0140-6736(91)92600-7Get rights and content

Abstract

The value of programmes to control pulmonary tuberculosis in developing countries remains the subject of debate. We have examined the cost-effectiveness of chemotherapy programmes for the control of pulmonary sputum-smear-positive tuberculosis in Malawi, Mozambique, and Tanzania. Effective cure rates of 86-90% were achieved with short-course chemotherapy and of 60-66% with standard chemotherapy. The average incremental costs per year of life saved were US $1·7-2·1 for short-course chemotherapy with hospital admission, $2·4-3·4 for standard chemotherapy with hospital admission, $0·9-1·1 for ambulatory short-course chemotherapy, and $0·9-1·3 for ambulatory standard chemotherapy. Chemotherapy for smear-positive tuberculosis is thus cheaper than other cost-effective health interventions such as immunisation against measles and oral rehydration therapy. Because the greatest benefit of chemotherapy is reduced transmission of the bacillus, treating HIV-seropositive, tuberculosis smear-positive patients would be only slightly less cost-effective than treating HIV-seronegative, tuberculosis-smear-positive patients.

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