Clarke Marina, Dick Judy, Bogg Lennart
Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa.
Scand J Public Health. 2006;34(1):83-91. doi: 10.1080/14034940510032220.
To establish the cost-effectiveness of lay health workers (LHWs) in conjunction with the current, local tuberculosis (TB) control programme, amidst health service contraction.
A cost-effectiveness analysis, comparing direct time costs of the current TB management strategy among permanent farm dwellers, with an intervention, whereby LHWs are involved in TB control activities on farms. Measure of effectiveness was case finding and cure rates of adult new smear-positive (NSP) TB cases, alongside a randomized control trial (RCT):
The observed cost reduction to the Boland Health District was 74% per case detected and cured on the intervention farms relative to the control farms. Intervention farms reached 83% successful treatment completion rate, control farms 65%. Although the successful treatment adherence was significantly different (18% letter). The improved case detection and cure rates were not statistically significant (chi-squared test). Direct LHW costs are borne by farmers. Farmers were motivated to bear costs by reduced job absenteeism and other positive side-effects. Even without outcome improvements costs per case cured were 59% lower on the intervention farms.
TB control has suffered from budget reductions in South Africa. It is critically important to develop cost-effective strategies to reduce the TB burden. Costs to public budgets can be substantially reduced while maintaining or improving case detection and treatment outcomes, by using farm-based LHWs.
在卫生服务缩减的情况下，结合当前当地的结核病控制项目，确定非专业卫生工作者（LHWs）的成本效益。
进行成本效益分析，比较常住农场居民中当前结核病管理策略的直接时间成本，以及一项干预措施的成本，该干预措施是让非专业卫生工作者参与农场的结核病控制活动。有效性衡量指标为成人新涂片阳性（NSP）结核病病例的病例发现率和治愈率，同时进行一项随机对照试验（RCT）。
与对照农场相比，干预农场每发现并治愈一例病例，博兰德卫生区的成本降低了74%。干预农场的成功治疗完成率达到83%，对照农场为65%。尽管成功治疗依从性有显著差异（相差18%）。病例发现率和治愈率的提高在统计学上并不显著（卡方检验）。非专业卫生工作者的直接成本由农民承担。农民因旷工减少和其他积极的副作用而愿意承担成本。即使没有改善结果，干预农场每治愈一例病例的成本也降低了59%。
南非的结核病控制因预算削减而受到影响。制定具有成本效益的策略以减轻结核病负担至关重要。通过使用以农场为基础的非专业卫生工作者，可以在维持或改善病例发现和治疗结果的同时，大幅降低公共预算成本。
