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

Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Programa Pós-graduação de Clínica Médica. Rio de Janeiro, RJ, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brazil / Instituto de Pesquisa Clínica e Translacional. Medicina ZARNS. Clariens Educação. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratório de Pesquisa Clínica e Translacional. Salvador, BA, Brasil.
Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brazil / Universidade Salvador. Curso de Medicina. Salvador, BA, Brasil.
Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brazil / Instituto de Pesquisa Clínica e Translacional. Medicina ZARNS. Clariens Educação. Salvador, BA, Brasil.
Fundação Medicina Tropical Doutor Heitor Vieira Dourado. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Programa de Pós-Graduação em Medicina Tropical. Manaus, AM, Brasil / Universidade Nilton Lins. Faculdade de Medicina. Manaus, AM, Brasil.
Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Programa Pós-graduação de Clínica Médica. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Programa Acadêmico de Tuberculose da Faculdade de Medicina. Rio de Janeiro, RJ, Brasil.
Instituto de Pesquisa Clínica e Translacional. Medicina ZARNS. Clariens Educação. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratório de Pesquisa Clínica e Translacional. Salvador, BA, Brasil.
Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Fundação Oswaldo Cruz, Porto Velho, Brasil. Laboratório de Análise e Visualização de Dados. Porto Velho, RO, Brasil.
Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Programa Pós-graduação de Clínica Médica. Rio de Janeiro, RJ, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brazil / Instituto de Pesquisa Clínica e Translacional. Medicina ZARNS. Clariens Educação. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratório de Pesquisa Clínica e Translacional. Salvador, BA, Brasil / Universidade Salvador. Curso de Medicina. Salvador, BA, Brasil.

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.

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Elsevier

Citation

DUARTE, Beatriz Barreto et al. Nationwide economic analysis of pulmonary tuberculosis in the Brazilian healthcare system over seven years (2015–2022): a population-based study. The Lancet Regional, Health – Americas, v. 39, p. 1-15, 2024.

DOI

org/10. 1016/j.lana.2024. 100905

ISSN

2667-193X

Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/67282

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