title: Impact of reduced hospitalisation on the cost of treatment for drug-resistant tuberculosis in South Africa.
abstract: METHODS
  The cost of multidrug-resistant tuberculosis (MDR-TB) treatment is a major barrier to treatment scale-up in South Africa.
  
  
  OBJECTIVE
  To estimate and compare the cost of treatment for rifampicin-resistant tuberculosis (RR-TB) in South Africa in different models of care in different settings.
  
  
  METHODS
  We estimated the costs of different models of care with varying levels of hospitalisation. These costs were used to calculate the total cost of treating all diagnosed cases of RR-TB in South Africa, and to estimate the budget impact of adopting a fully or partially decentralised model vs. a fully hospitalised model.
  
  
  RESULTS
  The fully hospitalised model was 42% more costly than the fully decentralised model (US$13,432 vs. US$7753 per patient). A much shorter hospital stay in the decentralised models of care (44-57 days), compared to 128 days of hospitalisation in the fully hospitalised model, was the key contributor to the reduced cost of treatment. The annual total cost of treating all diagnosed cases ranged from US$110 million in the fully decentralised model to US$190 million in the fully hospitalised model.
  
  
  CONCLUSIONS
  Following a more decentralised approach for treating RR-TB patients could potentially improve the affordability of RR-TB treatment in South Africa.
authors.affiliation: Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: E
authors.initials: E
authors.lastname: Sinanovic
authors.affiliation: Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Ramma
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Vassall
authors.affiliation: City Health, Cape Town Metro, South Africa.
authors.forename: V
authors.initials: V
authors.lastname: Azevedo
authors.affiliation: Médecins Sans Frontières, Khayelitsha, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Wilkinson
authors.affiliation: TB Cluster, National Department of Health, Pretoria, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Ndjeka
authors.affiliation: Aurum Institute, Johannesburg, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: McCarthy
authors.affiliation: Aurum Institute, Johannesburg, South Africa.
authors.forename: G
authors.initials: G
authors.lastname: Churchyard
authors.affiliation: Division of Medical Microbiology and Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: H
authors.initials: H
authors.lastname: Cox
mesh_terms: D000995:Antitubercular Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D018803:Models, Economic; D012293:Rifampin / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D013019:South Africa; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000191:economics
chemical_list: D000995:Antitubercular Agents; D012293:Rifampin