Treatment costs of directly observed therapy and traditional therapy for Mycobacterium tuberculosis: a comparative analysis.
OBJECTIVE
Treatment of tuberculosis is a time-consuming and expensive process, often complicated by patient non-adherence. Directly observed therapy (DOT), an out-patient management strategy designed to ensure adherence, is not widely used because it is perceived to be too expensive. This study compared costs of tuberculosis treatment in DOT to the same factors in traditional therapy.


METHODS
A retrospective economic evaluation of 659 tuberculosis cases was reported to a major metropolitan county public health department between 1980 and 1994. Out-patient costs, in-patient costs and the cost impact of relapse and acquired resistance were estimated in 1995 dollars.


RESULTS
Treatment costs were lower with DOT: $15,670 per case for in-patient care and $700 per case for out-patient care (P < 0.001). These cost differences resulted from shorter therapy duration (334 vs 550 days), fewer patient hospitalizations (58 vs 75%) and shorter hospital stays (26 vs 55 days per hospitalized patient). Relapse or acquired resistance occurred in 10.9% of patients and accounted for 35.7% of cost with traditional therapy, as compared to 1.2% of patients and 6.0% of cost with observed therapy.


CONCLUSIONS
Directly observed therapy is less costly than traditional therapy.
Weis
S E
SE
University of North Texas Health Science Center at Fort Worth, 76107, USA. sweis@hsc.unt.edu
Foresman
B
B
Matty
K J
KJ
Brown
A
A
Blais
F X
FX
Burgess
G
G
King
B
B
Cook
P E
PE
Slocum
P C
PC
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D002648:Child; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011635:Public Health Administration / Q000191:economics; D012189:Retrospective Studies; D013781:Texas; D014397:Tuberculosis, Pulmonary / Q000191:economics* / Q000628:therapy*