||The potential economic benefits of the DOTS strategy
against TB in India edited by Almeida J
||WHO Technical Information Series
The DOTS strategy has been demonstrated to overcome
most of the short-comings of self-administered chemotherapy such
as low cure rates, high relapse and fatality rates, drug resistance
etc. There are several benefits from successful application of the
DOTS strategy. The objective of this study was to estimate the direct
economic benefits by the reduction in the prevalence of TB and deaths
averted on account of DOTS. The methodology adopted has been the
comparison of the two scenario with DOTS and without
DOTS and deriving the benefits and calculating the discounted
value of the contributions of the DOTS by applying the discount
rates ranging from 5% to 16%. The estimates are generated by using
the marginal productivity of labour and the deaths averted by DOTS
among future workers in each age-sex-area category. The discounted
value of the contributions of the future workers among the deaths
averted in one year due to DOTS, the remaining years of their productive
life are considered as the economic benefits of the deaths averted.
The total benefits due to DOTS have been estimated as % of G.D.P.
in 1993-94 and annualized benefits due to DOTS as % of G.D.P. The
potential benefits are derived by using the most reliable 1993 estimates
from survey of causes of deaths.
The potential benefits of successful DOTS in India
are divided into two broad categories (I) Pure social welfare increasing
effects of DOTS which do not generate direct tangible economic benefits.
These would include reduced suffering of TB patients, quick and
sure cure from the disease, lives saved, disability reduced for
dependents and non-workers suffering from TB, the poverty alleviation,
the psychic benefits of living in a more healthy way. (ii) Direct
tangible economic benefits by improving the efficiency and productivity
due to reduction in prevalence of disease and deaths and release
of the hospital beds by averting hospitalization of TB patients.
The method of calculation is based on the estimates
of population for the base year 1993-94 by age-sex-area as well
as of the workers and sectors. Aggregative macro-economic studies
and estimates of productivity differentials are used to calculate
rural/urban, adult/child, young adult/old adult and male/female
workers output gains. These are applied to two groups with
DOTS and without DOTS and the benefits in the
improvements likely to occur with DOTS have been estimated.
The benefits are based on twin optimistic assumptions:
a) DOTS will succeed in tackling pulmonary TB in India (b) DOTS
will reach about 90% of TB patients with full instantaneous coverage.
It is envisaged to implement DOTS in a phased manner over a few
years. As per the findings of the analysis the potential economic
benefits of DOTS to the Indian economy is estimated to be around
4% of GDP in real terms or US $ 8.3 billion during 1993-94. The
economy gets a return of more than 16% per annum. Since the present
value of all future costs attributable to DOTS is likely to be less
than 4% of GDP, DOTS can effectively help step up Indias future
economic growth. Phasing in of DOTS over time reduces value of the
economic benefits. The longer the period of phasing, the lower is
the discounted value of the benefits. Even with 10 years of phasing
and 16% of discount rate all future benefits of DOTS turn out to
be 2.1% of G.D.P. Projected incremental costs to the government
for successful DOTS implementation throughout India are of the order
of US $ 200 million per year, compared to the tangible economic
benefits of at least US $ 750 million per year exceeding by several
folds of the financial costs.
|KEY WORDS: HEALTH ECONOMICS; DOTS; ECONOMIC BENEFITS;