Barreto-Duarte Beatriz, Villalva-Serra Klauss, Campos Vanessa M S, Cordeiro-Santos Marcelo, Kritski Afrânio L, Araújo-Pereira Mariana, Rodrigues Moreno M, Andrade Bruno B
Programa Pós-graduação de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.
Lancet Reg Health Am. 2024 Oct 10;39:100905. doi: 10.1016/j.lana.2024.100905. eCollection 2024 Nov.
Tuberculosis (TB) remains a global challenge and disproportionately affecting vulnerable populations. This study analyses the economic burden of pulmonary TB in Brazil, focusing on direct healthcare costs. It also evaluates the cost-effectiveness of the Directly Observed Treatment (DOT) strategy and the economic effort required to achieve a 90% probability of cure.
A nationwide retrospective study utilized data from the Brazilian Information System for Notifiable Diseases (SINAN) between 2015 and 2022. The cost per pulmonary TB case was estimated, encompassing expenses related to healthcare professionals, medication, laboratory exams, and the duration of treatment reported in SINAN. The population was stratified based on the presence of social vulnerabilities or a history of previous anti-TB treatment. Number Needed to Treat (NNT) analyses assessed the effectiveness of DOT implementation. Additionally, the study calculated the cost needed to achieve a 90% probability of cure through binomial regression models.
The total direct cost for pulmonary TB in Brazil during the seven years exceeded $1.3 billion, with retreatment cases accounting for $23.5 million. The lowest NNT of DOT were homeless (3.0), people who use drugs (3.72), and retreatment (4.56) subpopulations. These groups also presented the highest cost to achieve a 90% probability of cure.
This study highlights the economic impact of pulmonary TB on the Brazilian healthcare system. It underscores the effectiveness of DOT across various patient groups, regardless of their vulnerabilities or previous anti-TB treatment history. NNT analyses highlighted retreatment, homeless, and people who use drugs subpopulations as the most effective for DOT implementation.
Intramural Research Program-Oswaldo Cruz Foundation.
结核病仍然是一项全球性挑战，对弱势群体的影响尤为严重。本研究分析了巴西肺结核的经济负担，重点关注直接医疗成本。它还评估了直接观察治疗（DOT）策略的成本效益以及实现90%治愈概率所需的经济投入。
一项全国性回顾性研究利用了2015年至2022年巴西法定传染病信息系统（SINAN）的数据。估计了每例肺结核病例的成本，包括与医疗专业人员、药物、实验室检查以及SINAN报告的治疗持续时间相关的费用。根据社会脆弱性的存在或既往抗结核治疗史对人群进行分层。治疗所需人数（NNT）分析评估了DOT实施的有效性。此外，该研究通过二项式回归模型计算了实现90%治愈概率所需的成本。
七年间巴西肺结核的总直接成本超过13亿美元，复治病例占2350万美元。DOT的最低NNT出现在无家可归者（3.0）、吸毒者（3.72）和复治（4.56）亚人群中。这些群体在实现90%治愈概率方面的成本也最高。
本研究突出了肺结核对巴西医疗系统的经济影响。它强调了DOT在不同患者群体中的有效性，无论其脆弱性或既往抗结核治疗史如何。NNT分析突出了复治、无家可归者和吸毒者亚人群是实施DOT最有效的群体。
奥斯瓦尔多·克鲁兹基金会内部研究项目。
