Patients' Costs and Cost-Effectiveness of Tuberculosis Treatment in DOTS and Non-DOTS Facilities in Rio de Janeiro, Brazil

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

Imunidade celular de pacientes portadores de Tuberculose pulmonar. Participação do fator transformador de crescimento beta (TGF-beta) e interferon gama (IFN-gama)

Orientadores: Leonilda Maria Barbosa Santos, Ilma Aparecida PaschoalDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de BiologiaMestradoImunologiaMestre em Ciências Biológica

Patient costs according to outcome in non-DOT facilities.

<p>US$1.00 = R$1.80.</p

Direct and indirect costs (in US$) incurred by 218 patients before and after diagnosis according to the treatment strategy.

<p>SAT = self-administered therapy; DOT = directly observed therapy. N = Number of people in each category; <i>n</i> =  Number of people who reported any cost (mean values include those patients who reported costs zero). US$1.00 = R$1.80.</p

Sensitivity analyses for varying differences of outcomes, length and rates of hospitalization, staff salaries and frequency of treatment supervision.

<p>ICER = Incremental Cost-Effectiveness Ratio.</p><p>pct = patient completing treatment.</p><p>US$1.00 = R$1.80.</p

Incremental Cost-Effectiveness Ratio (ICER) according to different treatment completion rates in DOT facilities.

<p>The incremental cost-effectiveness ratio was calculated according to an increasing treatment completion rate in treatment facilities offering DOT. The red line represents the ICER taking into account only the costs to the health system.</p

Characteristics of 218 patients interviewed in Rio de Janeiro state, Brazil, according to the treatment strategy.

<p>N =  number of patients in each category.</p><p>SAT = self-administered therapy.</p><p>DOT = directly observed therapy.</p