Impact of reduced hospitalisation on the cost of treatment for drug-resistant tuberculosis in South Africa
OBJECTIVE: To estimate and compare the cost of treatment for rifampicin-resistant tuberculosis (RR-TB) in South Africa in different models of care in different settings.
DESIGN: We estimated the costs of different models of care with varying levels of hospitalisation. These costs were used to calculate the total cost of treating all diagnosed cases of RR-TB in South Africa, and to estimate the budget impact of adopting a fully or partially decentralised model vs. a fully hospitalised model.
RESULTS: The fully hospitalised model was 42% more costly than the fully decentralised model (US$13 432 vs. US$7753 per patient). A much shorter hospital stay in the decentralised models of care (44–57 days), compared to 128 days of hospitalisation in the fully hospitalised model, was the key contributor to the reduced cost of treatment. The annual total cost of treating all diagnosed cases ranged from US$110 million in the fully decentralised model to US$190 million in the fully hospitalised model.
CONCLUSION: Following a more decentralised approach for treating RR-TB patients could potentially improve the affordability of RR-TB treatment in South Africa.
Keywords: MDR-TB; budget impact; costing; decentralization; rifampicin-resistant tuberculosis
Document Type: Research Article
Affiliations: 1: Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa 2: London School of Hygiene & Tropical Medicine, London, UK 3: City Health, Cape Town Metro, South Africa 4: Médecins Sans Frontières, Khayelitsha, South Africa 5: TB Cluster, National Department of Health, Pretoria, South Africa 6: Aurum Institute, Johannesburg, South Africa 7: Division of Medical Microbiology and Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
Publication date: 01 February 2015
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