Box 2.1Use of Cost-Effectiveness to Set Policy: The Directly Observed Treatment Strategy

Nearly 2 million people die from tuberculosis (TB) each year, 98 percent of whom live in developing countries and most of whom are 15 to 49 years old. Meanwhile, anti-TB medicines are 95 percent effective in curing TB, even in low-income countries, and cost as little as US$10 for a six-month course of treatment or directly observed therapy short course (DOTS). The TB chapter of the first edition of this book (Murray, Styblo, and Rouillon 1993) and studies by Joesoef, Remington, and Jiptoherijanto (1989) and Kamolratanakul and others (1993) describe treatment of smear-positive TB with short-course chemotherapy as an extremely cost-effective intervention for TB.

Since 1980, the World Health Organization (WHO) has collaborated closely with many countries in East Asia and the Pacific to introduce short-course chemotherapy and then the DOTS strategy to achieve global targets, with a cure rate of 85 percent and a case-detection rate of 70 percent. In 1990, 10 countries were using short-course chemotherapy. In 1993, as a result of growing TB prevalence rates, WHO's declaration of a global emergency, and studies showing DOTS' cost-effectiveness, the DOTS strategy was established worldwide as the most effective response to TB. By 1995, DOTS had expanded to 73 countries, and by 2003, it had reached more than 180 countries worldwide (WHO 2004).

As of 1999, DOTS has been implemented with the collaboration of WHO in 13 provinces of China and has achieved a cure rate of 90 percent. The population in East Asia and the Pacific with access to DOTS increased from 44 percent in 1995 to 57 percent in 1997, with the proportion of registered TB patients who are enrolled in a DOTS program also increasing, from 30 percent in 1995 to 46 percent in 1997 (WHO 1999). The progress is mainly attributable to high-prevalence countries in the region, which include Cambodia, China, and the Philippines.

By 2002, national TB programs reported that 69 percent of the world's population lived in countries or parts of countries with DOTS coverage. DOTS programs treated a total of 13.3 million TB patients and 6.8 million smear-positive patients between 1995 and 2002.

From: Chapter 2, Intervention Cost-Effectiveness: Overview of Main Messages

Cover of Disease Control Priorities in Developing Countries
Disease Control Priorities in Developing Countries. 2nd edition.
Jamison DT, Breman JG, Measham AR, et al., editors.
Washington (DC): World Bank; 2006.
Copyright © 2006, The International Bank for Reconstruction and Development/The World Bank Group.

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