Cost analysis of paediatric tuberculosis treatment in Japan.
OBJECTIVE
To estimate the cost of treating a tuberculosis (TB) case and to analyse TB-related medical service utilisation, a cost-of-illness study was conducted for all patients with a primary diagnosis of TB admitted to a public hospital in Japan.


METHODS
Retrospective analysis by abstracting in- and out-patient medical records of 57 paediatric patients diagnosed with TB during 1993-1998 at a public hospital in Osaka prefecture. Costs were estimated based on third party's payer perspectives according to the service utilisation pattern. In addition to cost data, sociodemographic information and service utilisation pattern were also extracted from the medical records. Cost of preventing a case of TB was abstracted from the published literature.


RESULTS
The average cost of treatment was 8384 US dollars (95%CI 5667-11,099), while the average length of hospitalisation was 63 days (95%CI 43-84). Based on 20-80% vaccine efficacy, the cost of preventing a case of TB was 35,950-175,862 US dollars. In univariate analysis, site of TB (P = 0.04) was significantly associated with TB treatment cost, while case-finding method (contact tracing, symptoms, etc.) was associated with length of hospitalisation (P = 0.03). Multivariate regression analysis, however, showed none of the factors to be significant predictors of TB treatment cost and length of hospital stay.


CONCLUSIONS
The cost of treating a case of paediatric TB is much lower than that of preventing one. Japan's universal BCG vaccination policy should be re-examined in the light of economic, social and political issues.
Rahman
M
M
Department of General Medicine and Clinical Epidemiology, Kyoto University, Kyoto, Japan. rahman@kuhp.kyoto-u.ac.jp
Takahashi
O
O
Takamatsu
I
I
Sekimoto
M
M
Hira
K
K
Fukui
T
T
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006779:Hospitals, Public / Q000191:economics; D006801:Humans; D007564:Japan; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014376:Tuberculosis / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*