title: Resource utilization pattern and cost of tuberculosis treatment from the provider and patient perspectives in the state of Penang, Malaysia.
abstract: BACKGROUND
  Studies from both developed and developing countries have demonstrated a considerable fluctuation in the average cost of TB treatment. The objective of this study was to analyze the medical resource utilization among new smear positive pulmonary tuberculosis patients. We also estimated the cost of tuberculosis treatment from the provider and patient perspectives, and identified the significant cost driving factors.
  
  
  METHODS
  All new smear positive pulmonary tuberculosis patients who were registered at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were invited to participate in the study. Provider sector costs were estimated using bottom-up, micro-costing technique. For the calculation of costs from the patients' perspective, all eligible patients who agreed to participate in the study were interviewed after the intensive phase and subsequently at the end of the treatment by a trained nurse. PASW was used to analyze the data (Predictive Analysis SoftWare, version 19.0, Armonk, NY: IBM Corp.).
  
  
  RESULTS
  During the study period, 226 patients completed the treatment. However, complete costing data were available for 212 patients. The most highly utilized resources were chest X-ray followed by sputum smear examination. Only a smaller proportion of the patients were hospitalized. The average provider sector cost was MYR 992.34 (i.e., USD 325.35 per patient) whereby the average patient sector cost was MYR 1225.80 (i.e., USD 401.90 per patient). The average patient sector cost of our study population accounted for 5.7% of their annual family income. In multiple linear regression analysis, prolonged treatment duration (i.e., > 6 months) was the only predictor of higher provider sector costs whereby higher patient sector costs were determined by greater household income and persistent cough at the end of the intensive phase of the treatment.
  
  
  CONCLUSIONS
  In relation to average provider sector cost, our estimates are substantially higher than the budget allocated by the Ministry of Health for the treatment of a tuberculosis case in Malaysia. The expenses borne by the patients and their families on the treatment of the current episode of tuberculosis were not catastrophic for them.
authors.affiliation: Department of Pharmacy, The Islamia University of Bahawalpur, Punjab, Pakistan. pharmacist_atif@yahoo.com.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Atif
authors.forename: Syed Azhar Syed
authors.initials: SA
authors.lastname: Sulaiman
authors.forename: Asrul Akmal
authors.initials: AA
authors.lastname: Shafie
authors.forename: Muhammad
authors.initials: M
authors.lastname: Asif
authors.forename: Zaheer-Ud-Din
authors.initials: ZU
authors.lastname: Babar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D006282:Health Personnel / Q000191:economics; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008296:Malaysia; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011446:Prospective Studies; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D055815:Young Adult