The cost-effectiveness of chemotherapy for pulmonary sputum smear-positive tuberculosis was examined in the national tuberculosis control programmes of Malawi, Mozambique and Tanzania. In these three programmes, routine cure rates have exceeded 80 per cent. Average, average incremental and marginal unit costs for standard, short-course and retreatment regimens with and without hospitalization have been measured. The average incremental cost per year of life saved through chemotherapy ranged from US $0.90-3.10. In all conditions, short-course chemotherapy is preferable to standard 12-month chemotherapy. When hospitalization during the intensive phase of chemotherapy increases the cure rate by 10-15 percentage points, it can be relatively cost-effective. Analysing the cost-effectiveness of short-course and standard chemotherapy, where the depth of the margin of benefit is different, illustrates some of the dangers of simplistic use of cost-effectiveness ratios.

Ambulatory Care↗

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Overview and epidemiologic assessment of the current global tuberculosis situation with an emphasis on control in developing countries.

The global epidemiologic situation of tuberculosis is reviewed, with emphasis on the disappointing achievements in its control in developing countries over the last three decades. In developed countries where prevalence of tuberculosis is low, it will take at least 30-50 years to eliminate the disease because of exacerbation by individuals who acquire infection abroad. In developing countries, 2-3 million deaths will occur among the estimated 4 million new smear-positive and 4 million new smear-negative and extrapulmonary cases of tuberculosis. The low cure rate with standard chemotherapy is the chief reason for failure of tuberculosis control in developing countries. The basic chemotherapeutic regimen (streptomycin for 2 months then a combination of isoniazid and thiacetazone for 12 months) does not achieve a high cure rate in developing countries. Under routine conditions the cure rate is high (90%) with an inexpensive 8-month regimen consisting of 2 months of strictly supervised daily administration of isoniazid, rifampin, pyrazinamide, and streptomycin and then 6 months of self-administration of a tablet containing both isoniazid and thiacetazone. A substantial decrease in the risk of tuberculous infection in developing countries is essential because of the increase in number of AIDS patients with tuberculosis. Vaccination alone, at least with the present vaccine, cannot substantially influence the epidemiologic situation but should be continued for children when its use is justified for prevention.

Acquired Immunodeficiency Syndrome↗

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