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. 2006 Aug 15;6:209.
doi: 10.1186/1471-2458-6-209.

Impact of DOTS Expansion on Tuberculosis Related Outcomes and Costs in Haiti

Free PMC article

Impact of DOTS Expansion on Tuberculosis Related Outcomes and Costs in Haiti

Vary Jacquet et al. BMC Public Health. .
Free PMC article


Background: Implementation of the World Health Organization's DOTS strategy (Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives.

Methods: Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$.

Results: Starting in 2003, DOTS expansion in Haiti is anticipated to cost $4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion.

Conclusion: A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.


Figure 1
Figure 1
Sample decision analysis tree for Haitian adult, initially without TB infection, nor HIV infection who acquires new TB infection.
Figure 2
Figure 2
Year by year costs or savings with DOTS expansion in Haiti from societal and government perspectives. Dashed line – government perspective, solid line – societal perspective.
Figure 3
Figure 3
Effect of differences in HIV sero-prevalence on the projected cumulative total TB related costs over 20 years in Haiti with the two strategies. Dashed line – status quo, solid line – DOTS expansion.
Figure 4
Figure 4
Effect of changes in the case detection rate with DOTS expansion on total societal savings over 20 years in Haiti.

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