OBJECTIVES: A strategic plan of the Brazilian Public Health System (Sistema Único de Saúde - SUS) is ongoing to reduce the weight of tuberculosis as a major health problem. This study presents a budgetary impact analysis of shortening treatment for multidrug-resistant (MDR-TB).

METHODS: To measure the budgetary impact, 04 different strategies to control MDR-TB at the national level for Brazil were compared. The reference scenario was the current long regimen for all (S0). The alternative scenarios were a short regimen with the available drugs plus bedaquiline corresponding to 50% of marketshare (S1); increasing this rate to 68% while leaving the long regimen just for failures and relapses (S2); a short regimen with bedaquiline for 45% of the cases, 15% treated with the short regimen without bedaquiline and 20% remaining with long regimen (S3). The target population was obtained from the Brazil Ministry of Health data. Direct costs related to follow-up and monitoring were considered for each strategy. A five years horizon was defined, the discount rate was 3% for costs and an inflation rate of 4% was also applied.

RESULTS: The alternative scenario S3 yielded an 5-year economy of US$ 5 million of public expenditure for MDR-TB treatment. The S1 allowed to save US$ 1.3 million in this period, while S2 leaded to a US$ 2.1 million reduction.

CONCLUSIONS: Potential savings were observed with different mixes of short regimen introduction at the populational level in Brazil. Detailed analyses may be conducted by de health system to provide the more efficient approach.