Nationwide economic analysis of pulmonary tuberculosis in the Brazilian healthcare system over seven years (2015–2022): a population-based study

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2024-10-10 DOI:10.1016/j.lana.2024.100905

{"title":"Nationwide economic analysis of pulmonary tuberculosis in the Brazilian healthcare system over seven years (2015–2022): a population-based study","authors":"","doi":"10.1016/j.lana.2024.100905","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Findings</h3><div>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.</div></div><div><h3>Interpretation</h3><div>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.</div></div><div><h3>Funding</h3><div><span>Intramural Research Program-Oswaldo Cruz Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0000,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Regional Health-Americas","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2667193X24002321","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

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.

Methods

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.

Findings

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.

Interpretation

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.

Funding

Intramural Research Program-Oswaldo Cruz Foundation.

查看原文本刊更多论文

七年内（2015-2022 年）巴西医疗保健系统中肺结核的全国经济分析：一项基于人口的研究

背景肺结核（TB）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。该研究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努力。方法一项全国范围的回顾性研究利用了巴西应报疾病信息系统 (SINAN) 在 2015 年至 2022 年期间的数据。对每个肺结核病例的成本进行了估算，包括与医护人员、药物、实验室检查以及 SINAN 报告的治疗时间相关的费用。根据是否存在社会脆弱性或既往抗结核治疗史对人群进行了分层。治疗需要量（NNT）分析评估了 DOT 的实施效果。此外，该研究还通过二项回归模型计算了实现 90% 治愈概率所需的成本。研究结果在这七年中，巴西肺结核的直接成本总额超过 13 亿美元，其中再治疗病例的成本为 2350 万美元。无家可归者（3.0）、吸毒者（3.72）和再治疗病例（4.56）是 DOT NNT 最低的亚人群。这项研究强调了肺结核对巴西医疗系统的经济影响。它强调了短期直接治疗在不同患者群体中的有效性，无论他们的易感性或既往抗结核治疗史如何。NNT分析强调了再治疗、无家可归者和吸毒者亚群对实施DOT最有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.