Cost determinants of tuberculosis management in a low-prevalence country
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: 2006-02-01
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