||Chaulk CP, Friedman M & Dunning R
||Modeling the epidemiology and economics of directly
observed therapy in Baltimore
||INT J TB & LUNG DIS 2000, 4 , 201-207
From 1958 to 1978, Baltimore maintained one of
the highest pulmonary TB rates in the US. But, from 1978 to 1992
its TB rate declined by 64.3% and its ranking for TB fell from second
highest among large US cites to twenty-eighth. This TB trend coincided
with the implementation of an aggressive DOT programme by Baltimores
Health Department through city based DOTS, community outreach, home
based DOTS by public health nurses. By 1992, nearly 80% of Baltimore
patients were treated by DOTS.
Modeling is used to estimate the range of TB cases
prevented in Baltimore under DOT. Case estimates equal the difference
between the observed number of TB cases in Baltimore versus the
expected number if Baltimores TB trend was replaced by the
TB trend for the US (low estimate) or the TB trend for all US cities
with over 250000 residents (high estimate). Economic savings are
It has been estimated that without DOT there would
have been between 1577 (53.6%) and 2233 (75.9%) more TB cases in
Baltimore, costing $18.8 million to $27.1 million. Cases prevented
and expenditures saved increased with increased DOT participation.
This model predicts that Baltimores TB decline
accompanying DOT resulted in health care savings equal to twice
the citys total TB control budget for this period. These results
are most plausibly due to DOT, since it was the only major change
in Baltimores TB control programme and rising TB risk factors
AIDS, injection drug use, poverty in a city where
TB had been epidemic should have triggered a TB increase as in comparable
US cities, rather than the observed decline. As national TB rates
continue to decline it will be important to identify ways to capture
and reinvest these savings to support effective TB control programmes.
|KEY WORDS:; HEALTH ECONOMICS; USA.