The project aimed to improve the health care delivery in government hospital through the identification of more efficient health care management tools. Specifically the study sought to: (1) evaluate the efficacy of the short course standard daily triple and quadruple drug regimens for patients with sputum-positive pulmonary tuberculosis as reported in published randomized controlled trials; (2) review data on drug resistance of the tubercle bacilli in the Philippines; (3) determine the clinical experience of physicians who are using standard triple-drug regimen for pulmonary tuberculosis through a mail survey; (4) analyze which therapeutic regimen is more cost-beneficial and (5) make a sensitivity analysis to find out at what relapse and treatment failure rates quadruple-drug regimen is cheaper than triple-drug regimen.
A literature review of foreign and local randomized controlled trials for six month daily chemotherapy for pulmonary tuberculosis was done to compare which treatment program, is more cost-effective, the standard triple-drug regimen or the quadruple-drug regimen. The study included a review of the local studies for drug resistance against anti-TB drugs. Likewise, a mail survey was made to determine the actual clinical experience of physicians all over the country on the effectiveness of the triple-drug regimen for pulmonary tuberculosis. Computations made based on the literature review showed the total program cost for treating 100 patients for the four-drug regimen is higher by P14,934 compared to the triple-drug regimen. This can be explained by the higher efficacy of the quadruple regimen. However, local studies have noted the higher incidence of drug-resistance to anti-tuberculosis drugs including ethambutol. The result of the survey, which had 237 respondents, suggested that a small percentage (38.9%) of physicians believe that the standard regimen is less effective with 38 of them (42.4%) attributing this to drug resistance. The threshold analysis disclosed that program cost for treating tuberculosis cases can be altered by different relapse and treatment failure rates. There is a need to determine the actual relapse and treatment failure rates in the local setting to be able to make an accurate cost-effectiveness analysis. The recommendation to make a quadruple-drug regimen to all Filipinos with pulmonary tuberculosis should be studied more closely so that the most effective and economic use of these drugs can be attained.