Tuberculosis in the Philippines

BPaL Regimen Costs [2]

A research sought to fill a knowledge gap about the real-world economic burden of BPaL, a WHO-endorsed treatment for DR-TB, in the Philippines. By analyzing patient and provider costs using rigorous economic evaluation methods, the study found that BPaL substantially reduces direct and indirect costs for patients. The use of patient surveys and financial reviews allowed for detailed cost capture, adding strength to the cost-effectiveness conclusions.

Crucially, BPaL not only demonstrated lower costs but also superior treatment success rates compared to current regimens. These results are especially impactful given the high burden of DR-TB in resource-constrained settings like the Philippines. The study's robust design — including standardized patient selection and multiple data sources — supports its credibility.

From a policy perspective, the data suggest that transitioning DR-TB treatment toward the BPaL regimen could improve both patient outcomes and economic efficiency. Lower healthcare visits and reduced catastrophic expenditures further emphasize its advantage in practical, real-world implementation.

The economic analysis, including favorable ACER and ICER values under established GDP thresholds, clearly supports the adoption of BPaL. With cost and health advantages converging, the study makes a strong case for the national TB program to prioritize BPaL in routine care beyond the operational research context.

Outpatient DM Costs [1]

In 2021, diabetes mellitus (DM) outpatient visits accounted for 3% to 13% of total outpatient visits across 11 study sites in the Philippines. The study assessed various unit costs associated with DM services, including risk assessments at USD 0.53 and screenings using fasting blood sugar (FBS) at USD 2.99 when conducted with a chemistry analyzer. Random plasma glucose (RPG) screenings were slightly lower, costing USD 1.67, while the oral glucose tolerance test (OGTT), offered in only one private hospital, had the highest cost at USD 23.72. HbA1c testing was available in select facilities, further contributing to screening and diagnostic costs.

The weighted mean monthly drug cost per DM patient was estimated at USD 7.67, with metformin costing USD 2.11 per month and gliclazide ranging from USD 2.92 to USD 3.22, depending on dosage. Among injectable drugs, biphasic isophane human insulin was the most commonly prescribed, with an average monthly cost of USD 29.45. Staff time was the primary cost driver for outpatient services not requiring laboratory tests, accounting for 70% to 92% of costs, while consumables made up 52% to 90% of the expenses for screening and diagnosis services.

The cost per DM case detected among TB patients was lowest when using the RPG plus FBS algorithm at USD 17.43 per case, and HbA1c plus FBS at USD 25.41. When screening was limited to patients aged over 45 years, these costs decreased to USD 11.73 and USD 16.17 per case, respectively. Overall, the monthly cost per DM outpatient ranged from USD 8.95 for drug prescriptions alone to USD 12.36 when monitoring and consultations were included. These findings provide essential data to inform planning and budgeting for integrated TB-DM care, although further research is needed to explore inpatient costs and the patient perspective.

References:

1. Yamanaka, T., Castro, M.C., Ferrer, J.P., Solon, J.A., Cox, S.E., Laurence, Y.V. and Vassall, A., 2024. Health system costs of providing outpatient care for diabetes in people with TB in the Philippines. IJTLD open, 1(3), pp.124-129.
2. Evans, D., Hirasen, K., Casalme, D.J., Gler, M.T., Gupta, A. and Juneja, S., 2024. Cost and cost-effectiveness of BPaL regimen used in drug-resistant TB treatment in the Philippines. IJTLD open, 1(6), pp.242-249.