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Household focused DOTS is cost-effective in Colombia

Household focused DOTS is cost-effective in Colombia. Nieto E 2 , López L 1,3 , del Corral H 1,3 , Marín D.M. 1,2 , Lopera, L.D. 2 , Molina, G. 2 , Arbeláez, M.P 1,2 . 1. Grupo de Investigación en Epidemiología, Universidad de Antioquia

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Household focused DOTS is cost-effective in Colombia

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  1. Household focused DOTS is cost-effective in Colombia Nieto E2, López L1,3, del Corral H1,3, Marín D.M. 1,2, Lopera, L.D. 2, Molina, G.2, Arbeláez, M.P1,2. 1. Grupo de Investigación en Epidemiología, Universidad de Antioquia 2. Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia 3. Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia Wehave no conflicts of interestsregardingthisinvestigation

  2. Where-whenthestudyoriginated Cohort of householdcontacts (HHCs) of pulmonary TB cases in Medellín, Colombia del Corral H et al (2009) PLoS ONE 4(12): e8257. 24 3 6 9 12 15 18 21 0 Month

  3. Question:is a householdcenteredapproachto DOTS costeffective? TREATMENT SUCCESS = Cured + Finished Social perspective: Patients and theirfamilies TB control programe Institutionsthatparticipate in TB control activities

  4. Studydesign: 2 comparisongroups YEAR 2006 2009 Traditional DOTS HHC - DOTS TB cases NOT enrolled in cohortstudy TB cases enrolled in cohortstudy Traditional DOTS TB cases NOT enrolled in cohortstudy

  5. MAIN FINDINGS

  6. Traditional DOTS (n=371) Household DOTS (n=164) Treatment outcome Treatment outcomes of TB patients treated during 2006: HH-DOTS vs. traditional DOTS n % 95% CI n % 95% CI Cured 223 60.1 55.0 - 65.2 125 76.2 69.4 - 83.0 Finished 37 10.0 6.8 - 13.2 19 11.6 6.4 - 16.8 Failure 4 1.1 0.3 - 2.7 5 3.0 1.0 - 7.0 Abandoned 47 12.7 9.1 - 16.2 7 4.3 0.9 - 7.7 Died 14 3.8 1.7 - 5.8 8 4.9 1.3 - 8.5 Transfered 44 11.9 8.4 -15.3 No data 2 0.5 0.1 - 1.9

  7. Household DOTS (n=364) Size of effect (Householdvs Standard) Traditional DOTS (n=475) Treatment outcome Comparison of treatment outcomes between those that had HH-DOTS in 2006 vs. patients diagnosed in 2009 n % 95% CI N % 95% CI Diff (%) 95% CI p-value Cured 218 45.9 41.3 -50.5 270 74.2 69.5 - 78.8 28.3 21.7 - 34.9 0.0000 Finished 58 12.2 9.2 -15.3 41 11.3 7.9 - 14.6 - 0.9 - 5.6 - 3.7 0.7540 Failure 5 1.1 0.3 -2.4 18 4.9 2.6 - 7.3 3.9 1.2 - 6.5 0.0013 Abandoned 118 24.8 20.9 -28,8 17 4.7 2.4 - 7.0 - 20.2 - 24.9 _ - 15.5 0.000 Died 19 4.0 2,1 -5,9 18 4.9 2.6 - 7.3 0.9 - 2.1 -4.0 0.6233 Transfered 57 12.0 9,0 - 15.0 0 0.0 _ -12.0 - 15.2 _- 9.0 0.0000 85.5 58.1

  8. Mean costs of HHC – DOTS and regular DOTS bytype of costs

  9. Cost effectiveness ratios and incremental costs of TB treatmentusingsameyearcomparisongroups

  10. Cost effectiveness ratios and incremental costs of TB treatment in Medellín, 2010(before and after)

  11. CONCLUSIONS • HH-DOTS is more costeffectivethantraditional DOTS: • - mean cost per case successfullytreated - (cost–effectiveness ratio) • - cost per additional case succesfullytreated - (incremental costs) • lowerwith HH DOTS thanwithtraditional DOTS • biggestburden of DOTS costsisonpatients and theirfamilies, • under HH-DOTS thisportiondecreases. • Resultsconsistentwiththosefoundbyotherswhoevaluated • Cost-Eff of ambulatoryapproachesto DOTS: • - Prado et al (2011 ) - Cad SaudePublica 27(5):944-52 - Brazil • - Ngandaet al (2003) - IJTLD 7 Suppl 1: S14-20 - Kenya • - Floyd et al (2003) IJTLD 7 Suppl 1: S29-37 - Malawi

  12. Acknowledgments Funding: COLCIENCIAS (Grant# 111549326088) Universidad de Antioquia’s CODI Researchgroupsustainabilityprograme. SpecialthankstoMaria Cecilia Oquendo and Alejandro Arango forenthusiastically and thoroughly done fieldwork. THANK YOU

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