9.4 Estimates (epidemiological and logistics)

Estimates are needed by the NTP and other health care providers, to determine the number of MDR/RR-TB patients eligible for the longer and shorter MDR-TB regimens, to revise the budget accordingly, and to submit the corresponding requests for drug orders, taking into account the existing stock of medicines. These estimates of MDR/RR-TB patients likely to be enrolled are based on current notification trends and an expected increase in line with national and subnational plans. The programme first establishes the number of MDR-TB enrolments expected in the coming years, depending on the future increase in programme capacity (e.g. as part of a project supported by a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria). Then, based on knowledge from surveillance, eligibility and estimated rate of scale-up, the programme defines different patient groups; for example, those expected to receive different variants of the longer MDR-TB regimens and those likely to receive a shorter MDR-TB regimen. When estimating the caseload to put on treatment, it is necessary to factor in not just eligibility, but also what would be feasible to achieve within a given time, to ensure that all elements are in place for starting and maintaining patients on treatment (e.g. training and provision of an adequate framework for patient monitoring and support). Associated programme and patient costs other than the medicines themselves usually dominate the total cost for both longer and shorter MDR-TB regimens (e.g. treatment of adverse events, hospitalization, diagnostic consumables, other clinical care and social support); however, total costs are expected to be lower for shorter regimens, given the shorter duration of treatment.

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