Cost determinants of tuberculosis management in a low-prevalence country
Abstract:SETTING: Division of respiratory medicine in a specialised infectious disease hospital in Rome, Italy.
OBJECTIVE: Retrospective evaluation of tuberculosis (TB) care associated costs in an integrated in- and out-patient management programme.
DESIGN: Review of the medical records of 92 human immunodeficiency virus negative TB cases admitted between September 2000 and May 2003.
RESULTS: Length of in-hospital stay (45 ± 35 days) was the major cost determinant, as hospitalisation accounted for almost 80% of the total costs of the case, with fixed bed-per-day charges amounting to 76% of hospital costs. Factors associated with higher costs were chest X-ray score, fever, sputum bacterial load and multidrug resistance (P < 0.05). Cure/treatment completion was achieved in 82% of patients entering the out-patient programme (63% of all cases). Homelessness, age and co-morbidities were associated with unfavourable outcomes.
CONCLUSIONS: A closely followed hospital-centred protocol carried out in a high-resource setting may produce acceptable cure/completion treatment rates. As a too high fraction of resources invested in TB control goes toward hospital costs, out-patient treatment strategies should be implemented.
Document Type: Regular Paper
Affiliations: 1: Division of Respiratory Medicine, University of Rome ‘Tor Vergata’ at the National Institute for Infectious Diseases (INMI) L Spallanzani, Rome, Italy 2: Postgraduate School of Respiratory Medicine, University of Rome ‘Tor Vergata’, Rome, Italy 3: Microbiology Department, INMI L Spallanzani, Rome, Italy 4: Diagnostic Department, INMI L Spallanzani, Rome, Italy 5: Department of Statistics, INMI L Spallanzani, Rome, Italy 6: Medical Director's Office, INMI L Spallanzani, Rome, Italy
Publication date: February 1, 2006
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.
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