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

Lancet. 1991 Nov 23;338(8778):1305-8. doi: 10.1016/0140-6736(91)92600-7.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Care / economics
  • Antitubercular Agents / economics*
  • Antitubercular Agents / therapeutic use
  • Clinical Protocols
  • HIV Seropositivity / complications
  • HIV Seropositivity / economics
  • Humans
  • Malawi
  • Mozambique
  • Sputum / microbiology
  • Tanzania
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / economics*
  • Tuberculosis, Pulmonary / mortality


  • Antitubercular Agents