Costs of investigating and managing non-residents with possible tuberculosis: New Zealand experience of an international problem.
OBJECTIVE
This study's aims were to identify the diagnoses, the public hospital costs and payments for non-New Zealand (non-NZ) patients referred because of possible tuberculosis (TB). There have been no previous financial studies in this area. Funding arrangements for these patients were also reviewed.


METHODS
A systematic, retrospective review was performed to identify the costs of investigating and managing non-NZ patients referred to the adult TB unit of a large, teaching hospital in Auckland, NZ. Patients were enrolled between 1 July 2002 and 30 June 2003.


RESULTS
Forty-five non-NZ patients were studied. The mean age was 33.8 (+/-13.4) years. Thirty-four (75.5%) were managed under compulsion through Section 9 of the NZ TB Act. Thirty-two (71%) patients received TB treatment: 11 (24%) had infectious pulmonary TB and four had active extra-pulmonary TB. There were no multi-drug-resistant isolates. Three TB cases accounted for 250 (39%) inpatient days. One patient with rifampicin-resistant TB was responsible for 117 (29%) day-patient ward visits. Four (13%) infectious TB cases were managed as inpatients for more than 6 weeks. The total cost of services (US dollars) for the 45 patients was 350,236 dollars. The cost range was 544-43,513 dollars per patient. Four patients incurred costs over 25,000 dollars.


CONCLUSIONS
TB in non-residents is a costly problem in NZ. Current policy applying to this area and the ability to determine its cost-effectiveness are in need of review.
Burns
Andrew D
AD
Green Lane Respiratory Services, Auckland City Hospital, Auckland, New Zealand.
Harrison
Adrian C
AC
D000328:Adult; D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D004641:Emigration and Immigration; D017721:Hospital Costs; D006801:Humans; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies; D014376:Tuberculosis / Q000188:drug therapy / Q000191:economics / Q000208:ethnology
D000995:Antitubercular Agents