Nationwide economic analysis of pulmonary tuberculosis in the brazilian healthcare system over seven years: prioritizing vulnerable populations for enhanced treatment strategies

Objetivo (s): Estimate the direct cost of PTB in Brazil, Test the impact of DOT on the cost of PTB care and the relation between cost and ATT outcomes Assess the monetary effort to achieve the standards of cure proposed by the WHO Material e Métodos: A nationwide retrospective study utilized data from the Brazilian Information System for Notifiable Diseases (SINAN-TB) between 2015 and 2022. The cost per PTB case was estimated, encompassing expenses related to healthcare professionals, medication, laboratory exams, and the duration of treatment reported in SINAN. Medication costs were determined based on the National Health Surveillance Agency (ANVISA) cost table. Human resource expenses considered family physician consultations and health agent home visits for DOT, while laboratory examination costs were derived from government-provided values for public health services. The population was stratified based on the presence of social vulnerabilities or a history of previous anti-TB treatment (ATT). Number Needed to Treat (NNT) analyses assessed the effectiveness of DOT implementation in different settings. Additionally, the study calculated the cost needed to achieve a 90% probability of cure through binomial regression models. Resultados e Conclusão: The total direct cost for PTB in Brazil during the seven years exceeded $108 million, with retreatment cases accounting for $19.8 million. NNT analyses highlighted retreatment, homeless, and Persons Using Drugs (PUD) subpopulations as the most effective for DOT implementation. The cost to achieve a 90% probability of cure was higher in the retreatment group, as well as in homeless and PUD populations. Overlaying retreatment history with social vulnerabilities increased the associated cost. This study highlights the significant economic impact of PTB on the Brazilian healthcare system. It underscores the effectiveness of DOT across various patient groups, regardless of their vulnerabilities or previous ATT history. Notably, homeless individuals and people who use drugs were identified as the subgroups with the largest NNT for DOT effectiveness.