Table 4– Average cost per patient treated for multidrug-resistant tuberculosis before and after the adoption of World Health Organization guidelines
Cost itemEstoniaTomsk Oblast, Russia
AfterBeforeAfterBefore
Hospitalisation#4491 (51)3366 (71)2987 (30)1113 (49)
Drugs2219 (25)911 (19)3718 (37)576 (26)
DOT visits to day-stay hospital ward+NANA783 (8)341 (15)
DOT visits to outpatient facilities including nutritional support§891 (10)61 (1)252 (3)97 (4)
Programme management and supervision615 (7)416 (4)
Technical assistance370 (4)
Laboratory support200 (2)
Laboratory testsƒ,##195 (2)155 (3)166 (2)35 (2)
Training128 (2)302 (3)
Advocacy288 (3)
Radiography, CT scans and clinical laboratory tests119 (1)128 (3)91 (1)20 (1)
Adverse events12 (0.1)2 (0.04)54 (1)
Other304 (1)106 (2)460 (5)72 (3)
Total8974 (100)4729 (100)10088 (100)2253 (100)
  • Data are presented as cost in US$ (% column total). The exchange rates used to convert costs in local currency to US$ were US$1 is equivalent to 14.7 Estonian kroons or 34.8 Russian roubles. DOT: directly observed treatment; CT: computed tomography; NA: not applicable. #: in Estonia, 192 days for World Health Organization (WHO) guidelines, and 132 days for the period before WHO guidelines were adopted at US$30.50 for the first 60 days and US$15.50 for any days thereafter; in Tomsk Oblast, 321 days for WHO guidelines, and 120 days for the period before WHO guidelines were adopted at US$9.30 per bed-day. : in Estonia, the drugs used included amikacin (Am), amoxicillin, capreomycin (Ca), clarithromycin (Cla), cycloserine (Cy), ethambutol (E), ethionamide (Et), isoniazid (H), kanamycin (K), ofloxacin (Of), para-aminosalicylic acid (PAS), prothionamide, rifampicin (R), streptomycin (S) and pyrazinamide (Z); in Tomsk Oblast, the typical patient received H, R, Z, E, S, Am, Ca, Cla, Cy, Et, K, Of, PAS, rifabutin and Amx. +: in Tomsk Oblast, 250 day-stays for WHO guidelines and 109 for the period before WHO guidelines were adopted, at a cost of US$3.10 per day-stay. §: in Estonia, 171 visits at US$5.20 per visit; in Tomsk Oblast, 85 visits at US$1.40 per visit. Nutritional support not provided before the adoption of WHO guidelines. In Tomsk Oblast, nutritional support was approximately US$130 per patient, or 52% of outpatient costs; in Estonia, these data were not recorded separately from other costs. ƒ: smears, cultures and drug susceptibility testing. ##: in Estonia, on average, each patient required 21.4 (liquid medium) cultures at US$5.50 each, 2.6 drug susceptibility tests (liquid medium) at US$17.50 each and 14.5 smears at US$2.00 each; in Tomsk Oblast, on average, each patient required 46.5 cultures at US$2.50 per culture, 3.9 (first- and second-line) drug susceptibility tests at US$4.00 each and 48.0 smears at US$0.50 each.