Background
Multidrug-resistant tuberculosis (MDR-TB) is an important global health problem, and a
control strategy known as DOTS-Plus has existed since 1999. However, evidence regarding the feasibility, effectiveness, cost, and cost-effectiveness of DOTS-Plus is still limited.

Methodology/Principal Findings
We evaluated the feasibility, effectiveness, cost, and cost-effectiveness of a DOTS-Plus pilot project established at Makati Medical Center in Manila, the Philippines, in 1999. Patients with MDR-TB are treated with regimens, including first- and second-line drugs, tailored to their drug susceptibility pattern (i.e., individualised treatment). We considered the cohort enrolled between April 1999 and March 2002. During this three-year period, 118 patients were enrolled in the project; 117 were considered in the analysis. Seventy-one patients (61%) were cured, 12 (10%) failed treatment, 18 (15%) died, and 16 (14%) defaulted. The average cost per patient treated was US$3,355 from the perspective of the health system, of which US$1,557 was for drugs, and US$837 from the perspective of patients. The mean cost per disability-adjusted life year (DALY) gained by the DOTS-Plus project was US$242 (range US$85 to US$426).

Conclusions
Treatment of patients with MDR-TB using the DOTS-Plus strategy and individualised drug
regimens can be feasible, comparatively effective, and cost-effective in low- and middle-income countries.

This issue of CHP/PCOR's quarterly newsletter, which covers news from the winter 2006 quarter, includes articles about:

• a comprehensive review of worldwide anthrax cases from 1900 to 2005, conducted by CHP/PCOR researchers, which found that timely diagnosis and antibiotic treatment, along with pleural fluid drainage, are key to anthrax patients' survival;
• an early-stage research project in which CHP/PCOR core faculty member Grant Miller is collaborating with an NGO in Bangladesh to study whether villagers' traditional cooking practices are contributing to life-threatening respiratory infections;
• assertions by two CHP/PCOR health policy experts that health-savings accounts -- the cornerstone of President Bush's healthcare agenda -- won't save much money and won't address the fundamental problems of the U.S. healthcare system;
• the Agency for Healthcare Research and Quality's release of the Pediatric Quality Indicators, developed by CHP/PCOR researchers and collaborators. This is the first set of data-analysis tools specifically designed to help hospitals monitor their quality of care for hospitalized children; and
• a roundup of CHP/PCOR's 7th annual retreat, which featured panel discussions on improving healthcare quality, conducting health services research in developing countries, and health systems comparisons across industrialized nations.

As Vietnam opens its economy to privatization, its system of healthcare will face a series of crucial tests. Vietnam's system of private healthcare -- once comprised only of individual physicians holding clinic hours in their homes -- has come to also include larger customer-oriented clinics based on an American business model. As the two models compete in the expanding private market, it becomes increasingly important to understand patients' perceptions of the alternative models of care.

This study reports on interviews with 194 patients in two different types of private-sector clinics in Vietnam: a western-style clinic and a traditional style, after-hours clinic. In bivariate and multivariate analyses, we found that patients at the western style clinic reported both higher expectations of the facility and higher satisfaction with many

aspects of care than patients at the after-hours clinic. These different perceptions appear to be based on the interpersonal manner of the physician seen and the clinic's delivery methods rather than perceptions of the physician's technical skill and method of treatment. These fndings were unaffected by the ethnicity of physician seen.

These fndings suggest that patients in Vietnam recognize and prefer more customer-oriented care and amenities, regardless of physician ethnicity and perceive no signiccant differences in technical skill between the private delivery models.