Cost determinants of tuberculosis management in a low-prevalence country.
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.
Bocchino
M
M
Division of Respiratory Medicine, University of Rome Tor Vergata at the National Institute for Infectious Diseases L Spallanzani, Rome, Italy.
Greco
S
S
Rosati
Y
Y
Mattioli
G
G
Marruchella
A
A
De Mori
P
P
Bibbolino
C
C
Girardi
E
E
Squarcione
S
S
Saltini
C
C
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*
D000995:Antitubercular Agents