TY - JOUR KW - Adult KW - Community Health Services KW - Cost-Benefit Analysis KW - Costs and Cost Analysis KW - Health Care Costs KW - Humans KW - Kenya KW - Primary Health Care KW - Rural Health Services KW - Rural Population KW - Tuberculosis, Pulmonary AU - Nganda B AU - Wang'ombe J AU - Floyd K AU - Kangangi J AB -

SETTING: Machakos District, Kenya, a rural area 50 km east of Nairobi.

OBJECTIVE: To assess the cost and cost-effectiveness of new treatment strategies for tuberculosis patients, involving decentralisation of care from hospitals to peripheral health units and the community, compared to the conventional approaches to care used until October 1997.

METHODS: Costs were analysed in 1998 US dollars from the perspective of health services, patients, family members and the community, using standard methods. Separate analyses were undertaken for 1) new smear-positive pulmonary patients and 2) new smear-negative and extrapulmonary patients. Cost-effectiveness was calculated as the cost per patient successfully completing treatment (smear-positive cases) and as the cost per patient completing treatment (new smear-negative and extra-pulmonary cases).

FINDINGS: The cost per patient treated for new smear-positive patients was dollars 591 with the conventional hospital-based approach to care, and dollars 209 with decentralised care. Costs fell from all perspectives, and by 65% overall. Cost-effectiveness improved by 66%. The cost per patient treated for new smear-negative/extra-pulmonary patients was dollars 311 with the conventional approach to care, and dollars 197 with decentralised care. Costs fell from all perspectives, and cost-effectiveness improved by 61%.

CONCLUSION: There is a strong economic case for expansion of decentralisation and strengthened community-based care in Kenya. The National Tuberculosis and Leprosy Control Programme will require new funds for start-up training and community mobilisation costs in order to do this.

BT - The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease C1 - http://www.ncbi.nlm.nih.gov/pubmed/12971650?dopt=Abstract DA - 2003 Sep IS - 9 Suppl 1 J2 - Int. J. Tuberc. Lung Dis. LA - eng N2 -

SETTING: Machakos District, Kenya, a rural area 50 km east of Nairobi.

OBJECTIVE: To assess the cost and cost-effectiveness of new treatment strategies for tuberculosis patients, involving decentralisation of care from hospitals to peripheral health units and the community, compared to the conventional approaches to care used until October 1997.

METHODS: Costs were analysed in 1998 US dollars from the perspective of health services, patients, family members and the community, using standard methods. Separate analyses were undertaken for 1) new smear-positive pulmonary patients and 2) new smear-negative and extrapulmonary patients. Cost-effectiveness was calculated as the cost per patient successfully completing treatment (smear-positive cases) and as the cost per patient completing treatment (new smear-negative and extra-pulmonary cases).

FINDINGS: The cost per patient treated for new smear-positive patients was dollars 591 with the conventional hospital-based approach to care, and dollars 209 with decentralised care. Costs fell from all perspectives, and by 65% overall. Cost-effectiveness improved by 66%. The cost per patient treated for new smear-negative/extra-pulmonary patients was dollars 311 with the conventional approach to care, and dollars 197 with decentralised care. Costs fell from all perspectives, and cost-effectiveness improved by 61%.

CONCLUSION: There is a strong economic case for expansion of decentralisation and strengthened community-based care in Kenya. The National Tuberculosis and Leprosy Control Programme will require new funds for start-up training and community mobilisation costs in order to do this.

PY - 2003 SP - S14 EP - 20 T2 - The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease TI - Cost and cost-effectiveness of increased community and primary care facility involvement in tuberculosis care in Machakos District, Kenya. VL - 7 SN - 1027-3719 ER -