Modeling the Cost-Effectiveness of Multi-Drug Resistant Tuberculosis Diagnostic and Treatment Services in Indonesia

This resolution was a response to the growing concern over the increasing prevalence of MDR-TB, which poses a significant challenge to global TB control efforts. MDR-TB is a form of TB that is resistant to at least two of the most effective first-line anti-TB drugs, making it more difficult and expensive to treat. Indonesia's TB control program has been working to address the issue of MDR-TB. The program has been implementing the World Health Organization's (WHO) recommended Directly Observed Therapy, Short-course (DOTS) strategy, which involves the use of directly observed therapy to ensure that patients complete their treatment regimen. However, despite these efforts, MDR-TB remains a significant problem in Indonesia. In 2009, a cohort of 144 MDR-TB patients was treated at Moewardi Hospital in Surakarta, Indonesia. The treatment program was implemented using the WHO-recommended DOTS strategy, and the patients received a combination of first-line and second-line anti-TB drugs. The treatment outcomes were monitored, and the results showed that 68 patients were cured, 3 patients completed treatment and were presumed cured, and the remaining patients failed, defaulted, died, or were transferred out. The total program cost for treating the 144 patients was USD 687,512. The individual cost of treating and curing a patient was USD 5,589, and the average program cost per patient cured was USD 9,683. The average program cost per death averted was USD 15,237. These results indicate that the treatment program was effective in curing a significant proportion of patients, but the costs were high. A model was developed to assess the cost-effectiveness of MDR-TB diagnostic and treatment services in Indonesia. The model was designed to be simple and easy to use, as skills in costing and model development are often weak in TB control programs. The model was used to analyze the costs and outcomes of the treatment program at Moewardi Hospital, and the results showed that the program was cost-effective. However, the results of the study are not considered robust enough for international comparisons, as the data are from only one hospital and the prices have not been adjusted to fit the treatment period. To address this limitation, the study recommends conducting the same analysis at other hospitals in Indonesia, adjusting the prices for inflation, and adding an indicator using Disability-Adjusted Life Years (DALYs). The study was conducted by Management Sciences for Health (MSH) under the Tuberculosis CARE I Program (TB CARE I) Project of the U.S. Agency for International Development (USAID). The authors of the study are David Collins and Zina Jarrah of MSH, and they wish to thank the Director of the National Tuberculosis Program, the staff of Moewardi Hospital, and other officials who supported the study. The study's findings have implications for TB control programs in Indonesia and other countries. The results suggest that MDR-TB treatment programs can be effective in curing a significant proportion of patients, but the costs are high. To address this challenge, TB control programs will need to prioritize cost-effective interventions and ensure that they have the necessary resources to implement effective treatment programs.