International Research Center of Excellence, Institute of Human Virology Nigeria, 252 Herbert Macaulay Way, Central Business District, Abuja, Nigeria.
KNCV Tuberculosis Foundation, The Hague, The Netherlands.
BMC Infect Dis. 2019 Jan 10;19(1):41. doi: 10.1186/s12879-018-3636-1.
Nigeria accounts for a significant proportion of the global drug-resistant tuberculosis (DR-TB) burden, a large proportion of which goes untreated. Different models for managing DR-TB treatment with varying levels of hospitalization are in use across Nigeria, however costing evidence is required to guide the scale up of DR-TB care. We aimed to estimate and compare the costs of different DR-TB treatment and care models in Nigeria.
We estimated the costs associated with three models of DR-TB treatment and care: Model (A) patients are hospitalized throughout the 8-month intensive phase, Model (B) patients are partially hospitalized during the intensive phase and Model (C) is entirely ambulatory. Costs of treatment, in-patient and outpatient care and diagnostic and monitoring tests were collected using a standardized data collection sheet from six sites through an ingredient's approach and cost models were based on the Nigerian National Tuberculosis, Leprosy and Buruli Ulcer Guideline - Sixth Edition (2014) and Guideline for programmatic and clinical management of drug-resistant tuberculosis in Nigeria (2015).
Assuming adherence to the Nigerian DR-TB guidelines, the per patient cost of Model A was $18,528 USD, Model B $15,159 USD and Model C $9425 USD. Major drivers of cost included hospitalization (Models A and B) and costs of out-patient consultations and supervision (Model C).
Utilizing a decentralized ambulatory model, is a more economically viable approach for the expansion of DR-TB care in Nigeria, given that patient beds for DR-TB treatment and care are limited and costs of hospitalized treatment are considerably more expensive than ambulatory models. Scale-up of less expensive ambulatory care models should be carefully considered in particular, when treatment efficacy is demonstrated to be similar across the different models to allow for patients not requiring hospitalization to be cared for in the least expensive way.
尼日利亚在全球耐多药结核病（DR-TB）负担中占很大比例，其中很大一部分未得到治疗。尼日利亚采用了不同的 DR-TB 治疗管理模式，住院程度不同，但需要成本证据来指导 DR-TB 护理的扩大。我们旨在估计和比较尼日利亚不同 DR-TB 治疗和护理模式的成本。
我们使用标准化数据收集表从六个地点通过成分法收集了与三种 DR-TB 治疗和护理模式相关的成本：模式 (A) 患者在 8 个月的强化期内全程住院，模式 (B) 患者在强化期内部分住院，模式 (C) 完全门诊。治疗、住院和门诊护理以及诊断和监测测试的成本是根据尼日利亚国家结核病、麻风病和布吕利溃疡指南-第六版（2014 年）和尼日利亚耐多药结核病方案和临床管理指南（2015 年）的成本模型计算的。
假设遵守尼日利亚 DR-TB 指南，模式 A 的每位患者成本为 18528 美元，模式 B 为 15159 美元，模式 C 为 9425 美元。成本的主要驱动因素包括住院治疗（模式 A 和 B）以及门诊咨询和监督费用（模式 C）。
鉴于用于 DR-TB 治疗和护理的患者床位有限，住院治疗的成本比门诊治疗模式昂贵得多，因此，利用分散的门诊模式是在尼日利亚扩大 DR-TB 护理的更经济可行的方法。在不同模式之间证明治疗效果相似的情况下，应仔细考虑扩大更便宜的门诊护理模式，以便能够以最便宜的方式照顾不需要住院治疗的患者。
