The Economic Cost of Non-adherence to TB Medicines Resulting from Stock-Outs and Loss to Follow-Up in the Philippines

Author: David Collins, Management Sciences for Health (MSH), Systems for Improving Access to Pharmaceuticals and Services (SIAPS)

The Philippines is one of the 22 high-burden countries but has had much success in treating TB over the last few years. However, stock-outs of some medicines and loss to follow-up remain problems. These result in treatment interruption which has an impact on the wellbeing of patients and their families, on the health system and on society and the economy in general. The study involved the collection of data on stock-outs and loss to follow-up for 2014 and on the impact of the resulting treatment interruption. The results were modeled in a new spreadsheet-based tool.

The key findings are that

  1. Possible stock-outs of DS-TB medicines in 2014 for 2,663 patients for one month could have resulted in an additional economic cost of as much as USD 21.2 million as well as 329 new drug-resistant cases and 588 deaths;
  2. Loss to follow-up of 8,870 DS-TB patients for 3 months in 2014 could have resulted in an additional economic cost of as much as USD 72.2 million as well as 1,132 new drug-resistant cases and 1,958 deaths; and
  3. Loss to follow-up of 777 MDR-TB patients for 5 months in 2014 could have resulted in additional economic costs of USD 12.9 million as well as 474 new MDR-TB cases and 233 related deaths and 349 new XDR-TB cases.

These represent a significant economic burden for the country and it is likely that the cost of addressing these problems would be much less than this burden. Investment in improving patient management and interventions to ensure the availability of good quality medicines and interventions to encourage and assist patient compliance will bring important and substantial health and economic benefits.

For more information contact dcollins@msh.org and read the technical brief.

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