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Free Content Treatment costs of directly observed therapy and traditional therapy for Mycobacterium tuberculosis: a comparative analysis

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OBJECTIVE: Treatment of tuberculosis is a time-consuming and expensive process, often complicated by patient non-adherence. Directly observed therapy (DOT), an out-patient management strategy designed to ensure adherence, is not widely used because it is perceived to be too expensive. This study compared costs of tuberculosis treatment in DOT to the same factors in traditional therapy.

DESIGN: A retrospective economic evaluation of 659 tuberculosis cases was reported to a major metropolitan county public health department between 1980 and 1994. Out-patient costs, in-patient costs and the cost impact of relapse and acquired resistance were estimated in 1995 dollars.

RESULTS: Treatment costs were lower with DOT: $15670 per case for in-patient care and $700 per case for out-patient care (P < 0.001). These cost differences resulted from shorter therapy duration (334 vs 550 days), fewer patient hospitalizations (58 vs 75%) and shorter hospital stays (26 vs 55 days per hospitalized patient). Relapse or acquired resistance occurred in 10.9% of patients and accounted for 35.7% of cost with traditional therapy, as compared to 1.2% of patients and 6.0% of cost with observed therapy.

CONCLUSIONS: Directly observed therapy is less costly than traditional therapy.
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Keywords: DOT; cost; relapse; resistance; tuberculosis

Document Type: Regular Paper

Affiliations: 1: University of North Texas Health Science Center at Fort Worth, Forth Worth, Texas, USA; and Texas Department of Health, Austin, Texas, USA 2: University of North Texas Health Science Center at Fort Worth, Forth Worth, Texas, USA; and Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University School of Medicine, Texas, USA 3: University of North Texas Health Science Center at Fort Worth, Forth Worth, Texas, USA 4: Tarrant County Public Health Department, Texas, USA

Publication date: 1999-11-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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