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


One of the key elements of successful tuberculosis (TB) control programs is adherence to treatment, and this is a cornerstone of most international and national policies and guidelines. Non-adherence is often due to patient-related factors, but can also be a result of provider issues, such as stock-outs of TB medicines. Non-adherence results in increases in length and severity of illness, deaths, disease transmission, and drug resistance. These have economic consequences in terms of costs and loss of income for patients and their families and also costs to the health system.

The Philippines is among 22 countries considered to have a high burden of TB, including multidrug-resistant (MDR) TB. The Philippines Department of Health (DOH) has an extensive TB program with directly observed treatment short (DOTS) courses for TB and programmatic management of drug-resistant TB for MDR- TB. In recent years, the National Tuberculosis Control Program (NTP) data and several studies have indicated problems with stock-outs of some TB medicines and with loss-to-follow-up. Both of these problems result in treatment interruption.

At the request of the NTP and USAID, a study was conducted to determine the health, mortality, and economic impact of stock-outs and loss-to-follow-up to justify greater investment in addressing these challenges.