Adewole Olanisun O, Oladele T, Osunkoya Arinola H, Erhabor Greg E, Adewole Temitayo O, Adeola Oluwaseun, Obembe Olufemi, Ota Martin O C
Department of Medicine of Medicine, Obafemi Awolowo University/Teaching Hospitals, Ile Ife. Nigeria
Ministry of Health, Osun State, Nigeria.
Trans R Soc Trop Med Hyg. 2015 Dec;109(12):783-92. doi: 10.1093/trstmh/trv091.
Directly observed treatment short-course (DOTS) strategy is an effective mode of treating TB. We aimed to study the cost effectiveness and patients' satisfaction with home based direct observation of treatment (DOT), an innovative approach to community-based DOT (CBDOT) and hospital based DOT (HBDOT).
A randomized controlled trial involving 150 newly diagnosed pulmonary TB patients in four TB clinics in Ile Ife , Nigeria, was done. They were randomly assigned to receive treatment with anti TB drugs for the intensive phase administered at home by a TB worker (CBDOT) or at the hospital (HBDOT). Outcome measures were treatment completion/default rates, cost effectiveness and patients' satisfaction with care using a 13 item patients satisfaction questionnaire (PS-13) at 2 months. This trial was registered with pactr.org: number PACTR 201503001058381.
At the end of intensive phase, 15/75 (20%) and 2/75 (3%) of patients in the HBDOT and CBDOT, respectively had defaulted from treatment, p= 0.01. Of those with pretreatment positive sputum smear, 97% (68/70) on CBDOT and 54/67 (81%) on HBDOT were sputum negative for AFB at the end of 2 months of treatment, p=0.01. The CBDOT method was associated with a higher patient satisfaction score compared with HBDOT (OR 3.1; 95% CI 1.25-7.70), p=0.001.The total cost for patients was higher in HBDOT (US$159.38) compared with the CBDOT (US$89.52). The incremental cost effectiveness ratio was US$410 per patient who completed the intensive phase treatment with CBDOT.
CBDOT is a cost effective approach associated with better compliance to treatment and better patient satisfaction compared to HBDOT.
直接观察短程治疗（DOTS）策略是治疗结核病的一种有效模式。我们旨在研究基于家庭的直接观察治疗（DOT）的成本效益以及患者满意度，这是一种基于社区的DOT（CBDOT）和基于医院的DOT（HBDOT）的创新方法。
在尼日利亚伊费岛的四家结核病诊所对150名新诊断的肺结核患者进行了一项随机对照试验。他们被随机分配接受抗结核药物治疗，强化期由结核病防治人员在家中给药（CBDOT）或在医院给药（HBDOT）。结局指标为治疗完成率/违约率、成本效益以及使用13项患者满意度问卷（PS - 13）在2个月时患者对护理的满意度。该试验已在pactr.org注册：编号PACTR 201503001058381。
在强化期结束时，HBDOT组和CBDOT组分别有15/75（20%）和2/75（3%）的患者中断治疗，p = 0.01。在治疗前痰涂片阳性的患者中，CBDOT组97%（68/70）和HBDOT组54/67（81%）在治疗2个月末痰抗酸杆菌涂片转阴，p = 0.01。与HBDOT相比，CBDOT方法的患者满意度得分更高（OR 3.1；95% CI 1.25 - 7.70），p = 0.001。HBDOT组患者总费用（159.38美元）高于CBDOT组（89.52美元）。采用CBDOT完成强化期治疗的患者每例增量成本效益比为410美元。
与HBDOT相比，CBDOT是一种具有成本效益的方法，与更好的治疗依从性和更高的患者满意度相关。
