Centre for International Health, University of Bergen, Overlege Danielsens Hus, Bergen, Norway.
PLoS One. 2010 Feb 17;5(2):e9158. doi: 10.1371/journal.pone.0009158.
Treatments by HEWs in the health posts and general health workers at health facility were compared along a community-randomized trial. Costs were analysed from societal perspective in 2007 in US $ using standard methods. We prospectively enrolled smear positive patients, and calculated cost-effectiveness as the cost per patient successfully treated. The total cost for each successfully treated smear-positive patient was higher in health facility ($158.9) compared with community ($61.7). Community-based treatment reduced the total, patient and caregiver cost by 61.2%, 68.1% and 79.8%, respectively. Involving HEWs added a total cost of $8.80 (14.3% of total cost) on health service per patient treated in the community.
CONCLUSIONS/SIGNIFICANCE: Community-based treatment by HEWs costs only 39% of what treatment by general health workers costs for similar outcomes. Involving HEWs in TB treatment is a cost effective treatment alternative to the health service, to the patients and the family. There is an economic and public health reason to consider involving HEWs in TB treatment in Ethiopia. However, community-based treatment requires initial investment to start its implementation, training and supervision.
ClinicalTrials.gov NCT00803322.
在社区随机试验中，比较了卫生所和卫生机构的一般卫生工作者的卫生教育工作者（HEWs）治疗。2007 年，从社会角度使用标准方法，以美元为单位分析成本。我们前瞻性地招募了涂片阳性患者，并计算了每位成功治疗的患者的成本效益，即每位成功治疗的涂片阳性患者的成本。与社区（61.7 美元）相比，卫生机构（158.9 美元）中每位成功治疗的涂片阳性患者的总成本更高。基于社区的治疗使总治疗、患者和护理人员的成本分别降低了 61.2%、68.1%和 79.8%。在社区中每治疗一位患者，卫生教育工作者的参与会使卫生服务增加 8.80 美元的总成本（占总成本的 14.3%）。
结论/意义：社区卫生教育工作者的治疗成本仅为一般卫生工作者治疗类似结果的 39%。在结核病治疗中，让 HEW 参与对卫生服务、患者和家庭来说都是一种具有成本效益的治疗替代方案。在埃塞俄比亚，考虑让 HEW 参与结核病治疗具有经济和公共卫生方面的原因。然而，基于社区的治疗需要初始投资来启动其实施、培训和监督。
ClinicalTrials.gov NCT00803322。
