Economic evaluation of short treatment for multidrug-resistant tuberculosis, Ethiopia and South Africa: the STREAM trial

By Jason J Madan, Laura Rosu, Mamo Girma Tefera  Craig van Rensburg  Denise Evans  Ivor Langley, Ewan M Tomeny, Andrew Nunn, Patrick PJ Phillips,I D Ruseng & S Bertel Squire  |  | 

Objective To investigate cost changes for health systems and participants, resulting from switching to short treatment regimens for
multidrug-resistant (MDR) tuberculosis.
Methods We compared the costs to health systems and participants of long (20 to 22 months) and short (9 to 11 months) MDR tuberculosis
regimens in Ethiopia and South Africa. Cost data were collected from participants in the STREAM phase-III randomized controlled trial and
we estimated health-system costs using bottom-up and top-down approaches. A cost–effectiveness analysis was performed by calculating
the incremental cost per unfavourable outcome avoided.
Findings Health-care costs per participant in South Africa were 8340.7 United States dollars (US$) with the long and US$ 6618.0 with the
short regimen; in Ethiopia, they were US$ 6096.6 and US$ 4552.3, respectively. The largest component of the saving was medication costs
in South Africa (67%; US$ 1157.0 of total US$ 1722.8) and social support costs in Ethiopia (35%, US$ 545.2 of total US$ 1544.3). In Ethiopia,
trial participants on the short regimen reported lower expenditure for supplementary food (mean reduction per participant: US$ 225.5) and
increased working hours (i.e. 667 additional hours over 132 weeks). The probability that the short regimen was cost–effective was greater
than 95% when the value placed on avoiding an unfavourable outcome was less than US$ 19 000 in Ethiopia and less than US$ 14 500 in
South Africa.
Conclusion The short MDR tuberculosis treatment regimen was associated with a substantial reduction in health-system costs and a lower
financial burden for participants.

Publication details

Bulletin of the World Health Organization