Tracing contacts of TB patients in Malaysia: costs and practicality

Abstract

Tuberculin skin testing (TST) and chest X-ray are the conventional methods used for tracing suspected tuberculosis (TB) patients. The purpose of the study was to calculate the cost incurred by Penang General Hospital on performing one contact tracing procedure using an activity based costing approach. Contact tracing records (including the demographic profile of contacts and outcome of the contact tracing procedure) from March 2010 until February 2011 were retrospectively obtained from the TB contact tracing record book. The human resource cost was calculated by multiplying the mean time spent (in minutes) by employees doing a specific activity by their per-minute salaries. The costs of consumables, Purified Protein Derivative vials and clinical equipment were obtained from the procurement section of the Pharmacy and Radiology Departments. The cost of the building was calculated by multiplying the area of space used by the facility with the unit cost of the public building department. Straight-line deprecation with a discount rate of 3% was assumed for the calculation of equivalent annual costs for the building and machines. Out of 1024 contact tracing procedures, TST was positive (≥10 mm) in 38 suspects. However, chemoprophylaxis was started in none. Yield of contact tracing (active tuberculosis) was as low as 0.5%. The total unit cost of chest X-ray and TST was MYR 9.23 (2.90 USD) & MYR 11.80 (USD 3.70), respectively. The total cost incurred on a single contact tracing procedure was MYR 21.03 (USD 6.60). Our findings suggest that the yield of contact tracing was very low which may be attributed to an inappropriate prioritization process. TST may be replaced with more accurate and specific methods (interferon gamma release assay) in highly prioritized contacts; or TST-positive contacts should be administered 6H therapy (provided that the chest radiography excludes TB) in accordance with standard protocols. The unit cost of contact tracing can be significantly reduced if radiological examination is done only in TST or IRGA positive contacts.

Potential effect of household contact management on childhood tuberculosis: a mathematical modelling study

“…Analyses of the health system costs of contact screening and diagnosing and treating tuberculosis infection from Uganda, Malaysia, and Vietnam suggest that this is a highly feasible target. 22 , 23 , 24 If in a particular setting the costs of intervention exceed this amount, then a priority task becomes how to deliver the necessary interventions more efficiently.…”

Resource utilization pattern and cost of tuberculosis treatment from the provider and patient perspectives in the state of Penang, Malaysia

“…The total provider sector cost was the sum of outpatient clinic costs (i.e., the sum of human resource cost, capital cost, electricity cost and consumables cost), hospitalization costs, chest X-ray costs (i.e., the sum of human resource cost, capital cost, electricity cost and consumables cost [ 23 , 24 ]), laboratory services costs (i.e., the sum of human resource cost, capital cost, electricity cost and consumables cost) and medicines costs of all patients included in the study. The average provider sector cost was obtained by dividing the total provider cost by the number of successfully treated patients.…”

“…The personnel time cost for each of the employees involved was calculated according to the pay scale of the Federal Civil Services Officers under the System of Remuneration Malaysia [ 25 ]. Prior to the calculation, these salaries were converted into the salary per minute (MYR/min) by assuming a daily working time of 8 hours and a monthly working time of 20 days [ 23 , 24 ]. The cost of each employee per single activity was obtained by multiplying the mean time (minutes) spent by that employee doing a specific activity by his/her salary per minute.…”

Factors associated with tuberculosis disease among children who are household contacts of tuberculosis cases in an urban setting in Malaysia

“…According to the Malaysian Clinical Practice Guidelines for TB, a child contact must be screened within 6 weeks of diagnosis of the index case [9]. However, previous studies conducted in Malaysia have revealed that most diagnosed TB cases remain heavily dependent on passive case detection, where patients have already developed sufficiently significant symptoms spurring them to seek medical treatment [10]. This is an undesirable outcome for any NTP, as TB is still prevalent in the country.…”