Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
PLoS One. 2010 Nov 17;5(11):e14014. doi: 10.1371/journal.pone.0014014.
Costs of tuberculosis diagnosis and treatment may represent a significant burden for the poor and for the health system in resource-poor countries.
The aim of this study was to analyze patients' costs of tuberculosis care and to estimate the incremental cost-effectiveness ratio (ICER) of the directly observed treatment (DOT) strategy per completed treatment in Rio de Janeiro, Brazil.
We interviewed 218 adult patients with bacteriologically confirmed pulmonary tuberculosis. Information on direct (out-of-pocket expenses) and indirect (hours lost) costs, loss in income and costs with extra help were gathered through a questionnaire. Healthcare system additional costs due to supervision of pill-intake were calculated considering staff salaries. Effectiveness was measured by treatment completion rate. The ICER of DOT compared to self-administered therapy (SAT) was calculated.
DOT increased costs during the treatment phase, while SAT increased costs in the pre-diagnostic phase, for both the patient and the health system. Treatment completion rates were 71% in SAT facilities and 79% in DOT facilities. Costs per completed treatment were US$ 194 for patients and U$ 189 for the health system in SAT facilities, compared to US$ 336 and US$ 726 in DOT facilities. The ICER was US$ 6,616 per completed DOT treatment compared to SAT.
Costs incurred by TB patients are high in Rio de Janeiro, especially for those under DOT. The DOT strategy doubles patients' costs and increases by fourfold the health system costs per completed treatment. The additional costs for DOT may be one of the contributing factors to the completion rates below the targeted 85% recommended by WHO.
结核病的诊断和治疗费用可能给贫困人群和资源匮乏国家的卫生系统带来沉重负担。
本研究旨在分析结核病患者的医疗费用，并估算巴西里约热内卢直接观察治疗（DOT）策略每完成一例治疗的增量成本效益比（ICER）。
我们对 218 例经细菌学确诊的肺结核成年患者进行了访谈。通过问卷收集了直接（自付费用）和间接（误工时间）成本、收入损失以及额外帮助的费用信息。考虑到员工工资，计算了因监督服药而增加的医疗保健系统成本。通过治疗完成率来衡量疗效。比较 DOT 与自我管理治疗（SAT）的 ICER。
DOT 增加了治疗期间的成本，而 SAT 增加了诊断前阶段的成本，无论是对患者还是对卫生系统而言都是如此。SAT 治疗设施的治疗完成率为 71%，DOT 治疗设施的治疗完成率为 79%。SAT 治疗设施中每位患者完成治疗的成本为 194 美元，卫生系统的成本为 189 美元，而 DOT 治疗设施中每位患者完成治疗的成本为 336 美元，卫生系统的成本为 726 美元。DOT 每完成一例治疗的 ICER 为 6616 美元。
在里约热内卢，结核病患者的费用很高，尤其是接受 DOT 治疗的患者。DOT 策略使患者的成本增加了一倍，使卫生系统每完成一例治疗的成本增加了四倍。DOT 的额外成本可能是导致完成率低于世卫组织建议的 85%目标的原因之一。
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