Bocchino M, Greco S, Rosati Y, Mattioli G, Marruchella A, De Mori P, Bibbolino C, Girardi E, Squarcione S, Saltini C
Division of Respiratory Medicine, University of Rome Tor Vergata at the National Institute for Infectious Diseases L Spallanzani, Rome, Italy.
Int J Tuberc Lung Dis. 2006 Feb;10(2):146-52.
Division of respiratory medicine in a specialised infectious disease hospital in Rome, Italy.
Retrospective evaluation of tuberculosis (TB) care associated costs in an integrated in- and out-patient management programme.
Review of the medical records of 92 human immunodeficiency virus negative TB cases admitted between September 2000 and May 2003.
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 comorbidities were associated with unfavourable outcomes.
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.
意大利罗马一家专业传染病医院的呼吸内科。
对综合门诊和住院管理项目中与结核病（TB）治疗相关的费用进行回顾性评估。
回顾2000年9月至2003年5月期间收治的92例人类免疫缺陷病毒阴性结核病病例的病历。
住院时间（45±35天）是主要的费用决定因素，因为住院费用几乎占病例总费用的80%，每日固定床位费用占住院费用的76%。与较高费用相关的因素有胸部X线评分、发热、痰菌载量和多重耐药性（P<0.05）。进入门诊项目的患者中82%（所有病例的63%）实现了治愈/完成治疗。无家可归、年龄和合并症与不良结局相关。
在资源丰富的环境中实施密切跟踪的以医院为中心的方案可能会产生可接受的治愈/完成治疗率。由于投入结核病控制的资源中过高比例用于医院费用，应实施门诊治疗策略。
