TY - JOUR
T1 - Costs and cost-effectiveness of alternative tuberculosis management strategies in South Africa - Implications for policy
AU - Wilkinson, David
AU - Floyd, Katherine
AU - Gilks, Charles F.
N1 - Copyright the Author(s). Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 1997
Y1 - 1997
N2 - Objective. To conduct an economic analysis of the Hlabisa community-based directly observed therapy management strategy for tuberculosis and to project costs of three alternative strategies. Setting. Hlabisa health district, KwaZulu-Natal, South Africa. Methods. An economic analysis comparing the current tuberculosis management strategy in Hlabisa with three alternative strategies (the Hlabisa strategy prior to 1991 based on hospitalisation, the national strategy and sanatorium care) in terms of costs to both health service and patient and of cost-effectiveness. Results. The current Hlabisa strategy was the most cost-effective (R3 799 per patient cured); compared with R98 307 for the strategy used prior to 1991, R9 940 for the national strategy, and R11 145 for sanatorium care. Between 71% and 88% of treatment costs lie with the health service, and hospitalisation (R119 per day) is the most expensive item. Prolonged hospitalisation is extremely expensive, but community care is cheaper (community clinic visit, R28; community health worker visit, R7). The total cost of supervising a patient in the community under the current Hlabisa strategy was R503, equivalent to 4.2 days in hospital. Drug costs (R157) are equivalent to just 1.3 days in hospital. Conclusion. Cost to both health service and patient can be substantially reduced by using community-based directly observed therapy for tuberculosis, a strategy that is cheap and cost-effective in Hlabisa. These findings have important national implications, supporting the goals of the new tuberculosis control programme.
AB - Objective. To conduct an economic analysis of the Hlabisa community-based directly observed therapy management strategy for tuberculosis and to project costs of three alternative strategies. Setting. Hlabisa health district, KwaZulu-Natal, South Africa. Methods. An economic analysis comparing the current tuberculosis management strategy in Hlabisa with three alternative strategies (the Hlabisa strategy prior to 1991 based on hospitalisation, the national strategy and sanatorium care) in terms of costs to both health service and patient and of cost-effectiveness. Results. The current Hlabisa strategy was the most cost-effective (R3 799 per patient cured); compared with R98 307 for the strategy used prior to 1991, R9 940 for the national strategy, and R11 145 for sanatorium care. Between 71% and 88% of treatment costs lie with the health service, and hospitalisation (R119 per day) is the most expensive item. Prolonged hospitalisation is extremely expensive, but community care is cheaper (community clinic visit, R28; community health worker visit, R7). The total cost of supervising a patient in the community under the current Hlabisa strategy was R503, equivalent to 4.2 days in hospital. Drug costs (R157) are equivalent to just 1.3 days in hospital. Conclusion. Cost to both health service and patient can be substantially reduced by using community-based directly observed therapy for tuberculosis, a strategy that is cheap and cost-effective in Hlabisa. These findings have important national implications, supporting the goals of the new tuberculosis control programme.
UR - http://www.scopus.com/inward/record.url?scp=0030908052&partnerID=8YFLogxK
M3 - Article
C2 - 9254789
AN - SCOPUS:0030908052
SN - 0256-9574
VL - 87
SP - 451
EP - 455
JO - South African Medical Journal
JF - South African Medical Journal
IS - 4
ER -