Health Policy and Planning Advance Access originally published online on September 9, 2005
Health Policy and Planning 2005 20(6):347-353; doi:10.1093/heapol/czi041
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Original article |
The burden of disease, economic costs and clinical consequences of tuberculosis in the Philippines
1 Institute for Global Health, University of California at San Francisco, 2 San Francisco Veterans Affairs Research Enhancement Award Program, San Francisco, 3 RAND, Santa Monica, 4 School of Public Health, University of California, Los Angeles, California, USA and 5 University of the Philippines School of Economics, Quezon City, Philippines
Correspondence: John Peabody, MD, PhD, Institute for Global Health, 50 Beale Street, Ste #1200, San Francisco, CA 94105, USA. Tel: +1 415 597-8200; Fax: +1 415 597-8299. E-mail: peabody{at}psg.ucsf.edu
Objective: To provide a multidisciplinary and comprehensive analysis on the impact of tuberculosis (TB) in a high incidence country.
Methods: Data from several large scale surveys, carried out between 1997 and 2001 in the Philippines, were used to: (1) perform a burden of disease (BoD) analysis, (2) model the economic costs to society due to lost wages, and (3) determine the clinical outcomes, including the costs of care, for a hypothetical cohort of TB cases.
Results: Over 500 000 disability-adjusted life years (DALYs) are lost due to illness and premature mortality from TB in the Philippines annually. This is equal to 9% of all years of life lost (YLL) in the Philippines. The combined economic losses due to premature mortality and morbidity total PhP8 billion (approximately US$145 million). Clinically, only 28% of patients with incident active TB are diagnosed and successfully treated, while 20% of patients will die without ever being diagnosed and 6% more will die after they are diagnosed because they do not receive adequate care. The costs of treating all expected cases requires between PhP475–1625 million (approximately US$8–29 million) annually.
Conclusion: The high burden of disease from TB, large economic losses from mortality and morbidity from TB and the poor clinical outcomes all suggest that there is an urgent need for an increased investment in TB control. The costs of providing this treatment appear to be significantly lower than the current economic losses.
Key Words: tuberculosis, pulmonary, burden of illness, costs, disease, Philippines