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Free Content Cost-effectiveness of home-based care versus hospital care for chronically ill tuberculosis patients, Francistown, Botswana

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SETTING: Francistown, Botswana, 1999.

OBJECTIVE: To determine the affordability and cost-effectiveness of home-based directly observed therapy (DOT) compared to hospital-based DOT for chronically ill tuberculosis (TB) patients, and to describe the characteristics of patients and their caregivers.

DESIGN: Costs for each alternative strategy were analysed from the perspective of the health system and caregivers, in 1998 US$. Caregiver costs were assessed using a structured questionnaire administered to a sample of 50 caregivers. Health system costs were assessed using interviews with relevant staff and documentary data such as medical records and expenditure files. These data were used to calculate the average cost of individual components of care, and, for each alternative strategy, the average cost per patient treated. Cost-effectiveness was calculated as the cost per patient compliant with treatment. The characteristics of caregivers and patients were assessed using demographic and socio-economic data collected during interviews, and medical records.

RESULTS: Overall, home-based care reduced the cost per patient treated by 44% compared with hospital-based treatment ($1657 vs. $2970). The cost to the caregiver was reduced by 23% ($551 vs. $720), while the cost to the health system was reduced by 50% ($1106 vs. $2206). The cost per patient complying with treatment was $1726 for home-based care and $2970 for hospitalisation. Caregivers were predominantly female relatives (88%), unemployed (48%), with primary school education or less (82%), and with an income of less than $1000 per annum (71%). Of those patients with an HIV test result, 98% were HIV-positive.

CONCLUSION: Home-based care is more affordable and cost-effective than hospital-based care for chronically ill TB patients, although costs to caregivers remain high in relation to their incomes. Structured home-based DOT should be included as a component of the National Tuberculosis Control Programme in Botswana.
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Keywords: Botswana; cost-effectiveness; human immunodeficiency virus; treatment; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Ministry of Health, Gaborone, Botswana 2: Stop TB Department, World Health Organization, Geneva, Switzerland 3: The BOTUSA Project, Gaborone, Botswana 4: Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 5: The BOTUSA Project, Gaborone, Botswana; and the Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Publication date: 2003-09-01

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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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