Economic evaluations of diagnosis and treatment programmes for tuberculosis in developing countries: a review

This paper reviews recent economic evaluations of diagnostic pathways and treatments of TB in poorly resourced and highly burdened countries. The limited number of studies and their methodological weaknesses make it difficult to draw strong policy conclusions, especially in the field of diagnosis. The evidence points to a possible gain in cost-efficiency by moving from the Ziehl-Neelsen staining method to fluorescence microscopy and from three to two sputum examinations. Nevertheless, further research is indispensable. Concerning treatment, the community-based DOTS approach has proved more cost-effective than the conventional approach. With respect to other treatment alternatives, less evidence is available, but two promising possibilities are the expansion of DOTS by collaboration with the private sector and the introduction of second-line drugs for chronic disease.