Cost and cost-effectiveness of increased community and primary care facility involvement in tuberculosis care in Machakos District, Kenya.
METHODS
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).


RESULTS
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%.


CONCLUSIONS
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.
Nganda
B
B
Department of Economics, University of Nairobi, Nairobi, Kenya. bmnganda@ics.uonbi.ac.ke
Wang'ombe
J
J
Floyd
K
K
Kangangi
J
J
D000328:Adult; D003153:Community Health Services / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007630:Kenya; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000191:economics; D012424:Rural Population; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000191:economics*