Cost and cost-effectiveness of community based and health facility based directly observed treatment of tuberculosis in
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BioMed Central
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Cost and cost-effectiveness of community based and health facility based directly observed treatment of tuberculosis in Dar es Salaam, Tanzania Eliud Wandwalo*1,2, Bjarne Robberstad1 and Odd Morkve1 Address: 1Centre for International Health, University of Bergen, Armauer Hansen Building, N-5021, Bergen, Norway and 2National Tuberculosis and Leprosy Programme, Ministry of Health, P.O Box 9083, Dar es Salaam, Tanzania Email: Eliud Wandwalo* - [email protected]; Bjarne Robberstad - [email protected]; Odd Morkve - [email protected] * Corresponding author
Published: 14 July 2005 Cost Effectiveness and Resource Allocation 2005, 3:6 6
doi:10.1186/1478-7547-3-
Received: 10 January 2005 Accepted: 14 July 2005
This article is available from: http://www.resource-allocation.com/content/3/1/6 © 2005 Wandwalo et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Identifying new approaches to tuberculosis treatment that are effective and put less demand to meagre health resources is important. One such approach is community based direct observed treatment (DOT). The purpose of the study was to determine the cost and cost effectiveness of health facility and community based directly observed treatment of tuberculosis in an urban setting in Tanzania. Methods: Two alternative strategies were compared: health facility based directly observed treatment by health personnel and community based directly observed treatment by treatment supervisors. Costs were analysed from the perspective of health services, patients and community in the year 2002 in US $ using standard methods. Treatment outcomes were obtained from a randomised-controlled trial which was conducted alongside the cost study. Smear positive, smear negative and extra-pulmonary TB patients were included. Cost-effectiveness was calculated as the cost per patient successfully treated. Results: The total cost of treating a patient with conventional health facility based DOT and community based DOT were $ 145 and $ 94 respectively. Community based DOT reduced cost by 35%. Cost fell by 27% for health services and 72% for patients. When smear positive and smear negative patients were considered separately, community DOT was associated with 45% and 19% reduction of the costs respectively. Patients used about $ 43 to follow their medication to health facility which is equivalent to their monthly income. Indirect costs were as important as direct costs, contributing to about 49% of the total patient's cost. The main reason for reduced cost was fewer number of visits to the TB clinic. Community based DOT was more cost-effective at $ 128 per patient successfully treated compared to $ 203 for a patient successfully treated with health facility based DOT. Conc
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