title: Cost determinants of tuberculosis management in a low-prevalence country.
abstract: METHODS
  Division of respiratory medicine in a specialised infectious disease hospital in Rome, Italy.
  
  
  OBJECTIVE
  Retrospective evaluation of tuberculosis (TB) care associated costs in an integrated in- and out-patient management programme.
  
  
  METHODS
  Review of the medical records of 92 human immunodeficiency virus negative TB cases admitted between September 2000 and May 2003.
  
  
  RESULTS
  Length of in-hospital stay (45 +/- 35 days) was the major cost determinant, as hospitalisation accounted for almost 80% of the total costs of the case, with fixed bed-per-day charges amounting to 76% of hospital costs. Factors associated with higher costs were chest X-ray score, fever, sputum bacterial load and multidrug resistance (P < 0.05). Cure/treatment completion was achieved in 82% of patients entering the out-patient programme (63% of all cases). Homelessness, age and comorbidities were associated with unfavourable outcomes.
  
  
  CONCLUSIONS
  A closely followed hospital-centred protocol carried out in a high-resource setting may produce acceptable cure/completion treatment rates. As a too high fraction of resources invested in TB control goes toward hospital costs, out-patient treatment strategies should be implemented.
authors.affiliation: Division of Respiratory Medicine, University of Rome Tor Vergata at the National Institute for Infectious Diseases L Spallanzani, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bocchino
authors.forename: S
authors.initials: S
authors.lastname: Greco
authors.forename: Y
authors.initials: Y
authors.lastname: Rosati
authors.forename: G
authors.initials: G
authors.lastname: Mattioli
authors.forename: A
authors.initials: A
authors.lastname: Marruchella
authors.forename: P
authors.initials: P
authors.lastname: De Mori
authors.forename: C
authors.initials: C
authors.lastname: Bibbolino
authors.forename: E
authors.initials: E
authors.lastname: Girardi
authors.forename: S
authors.initials: S
authors.lastname: Squarcione
authors.forename: C
authors.initials: C
authors.lastname: Saltini
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D015995:Prevalence; D012189:Retrospective Studies; D014376:Tuberculosis / Q000453:epidemiology / Q000628:therapy*
chemical_list: D000995:Antitubercular Agents