Cost-effectiveness of community health worker versus home-based guardians for directly observed treatment of tuberculosis in Vitória, Espírito Santo State, Brazil

Abstract

The objective of this study was to compare the costs and outcomes associated with guardian-supervised directly observed treatment relative to the standard of care Directly Observed Therapy, Short Course (DOTS) provided by community health workers (CHW). New cases of culture-positive pulmonary tuberculosis (TB) treated in Vitória, Espírito Santo State, Brazil, between January 2005 and December 2006 were interviewed and chose their preferred treatment strategy. Costs incurred by providers and patients (and patients’ families) were estimated, and cost-effectiveness was assessed by comparing costs per successfully treated patient. 130 patients were included in the study; 84 chose CHW-supervised DOTS and 46 chose guardian-supervised DOTS. 45 of 46 (98%) patients treated with guardian-supervised DOTS were cured or completed treatment compared to 70/84 (83%) of the CHW-supervised patients (p = 0.01). Logistic regression showed only the strategy of supervision to be a significant association with treatment outcome, with guardian-supervised care strongly protective. Cost per patient treated with guardian-supervised DOTS was US$398, compared to US$548 for CHW-supervised DOTS. The guardian-supervised DOTS is an attractive option to complement CHW-supervised DOTS.

Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries

“…Strategies for reducing costs included task shifting treatment supervision to health workers in the community [35–41], to home guardians or close relatives [42], laypersons [43], and in one case entrusting patients to take medicine without direct supervision [13]. Programmatic and clinical indicators, such as treatment success rate, treatment completion rate, and case finding rate, also indicate that task shifting programs maintained programmatic quality comparable or superior to traditional models of care.…”

Different challenges, different approaches and related expenditures of community-based tuberculosis activities by international non-governmental organizations in Myanmar

“…Studies across Africa found the cost per patient of completing treatment under community -based TB care were quite varied, from US$ 60.7 in Ethiopia, US$ 128 in Tanzania and US$ 726 for new cases and US$ 1 419 for retreatment cases in South Africa [14–16]. Studies done in Bangladesh and Brazil showed that it cost US$ 64 and US$ 548 respectively for a patient to complete treatment by community-based TB care [17, 18]. The cost for community-based TB care in Myanmar seemed relatively higher than most of the previous international studies.…”

Costos de bolsillo de pacientes con diagnóstico de Tuberculosis en Colombia

“…Esto básicamente porque los pacientes no tienen que trasladarse a los centros de salud, si no que en su sitio de residencia o lugar de trabajo reciben la visita de supervisión. Situación que representa indiscutiblemente un ahorro en tiempo y dinero para los pacientes (15) .…”