title: Cost-optimization in the treatment of multidrug resistant tuberculosis in Nigeria.
abstract: OBJECTIVE
  To compare the cost of facility-based MDR TB care (F) to home-based care (H) from the perspective of the Nigerian national health system.
  
  
  METHODS
  We assessed the expected costs of the two MDR TB treatment approaches using a decision-analytic model with a follow-up of 6 months. MDR TB treatment outcomes were obtained from a systematic review of randomised clinical trials. The outcomes of interest included treatment success, treatment failure, treatment default and mortality and did not vary significantly between the two alternatives. Treatment costs included the cost of the following: drug therapy (F, H), hospital stay (F), nurse care (F, H), physician care (F), nursing facility (F) and transport to the healthcare provider (H). Finally, we estimated the potential cost savings associated with home-based treatment for all patients starting MDR TB treatment in Nigeria.
  
  
  RESULTS
  The average expected total treatment cost for a Nigerian patient treated for MDR TB was estimated at US2095 for facility - based care and 1535 for home-based care, a potential saving of 25%. One of the major drivers of this difference is significantly more intensive, and therefore more costly, nursing care in hospitals. In 2013, a total of 426 patients were initiated on facility-based MDR TB treatment in Nigeria. Thus, the potential savings through home-based care are US$ 223 204 per year.
  
  
  CONCLUSIONS
  In Nigeria, treatment of MDR TB using home-based care is expected to result in similar patient outcomes at markedly reduced public health costs as facility-based care.
authors.affiliation: Bayero University, Kano, Nigeria.
authors.forename: Baba Maiyaki
authors.initials: BM
authors.lastname: Musa
authors.affiliation: People's Open Access Education Initiative, Manchester, England.
authors.forename: Denny
authors.initials: D
authors.lastname: John
authors.affiliation: College of Health Sciences, Bayero University, Kano, Nigeria.
authors.forename: Abdulrazaq G
authors.initials: AG
authors.lastname: Habib
authors.affiliation: Department of Global Pricing and Market Access, Celgene Corporation, Warren, NJ, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kuznik
mesh_terms: D000995:Antitubercular Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics*; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000191:economics* / Q000451:nursing
chemical_list: D000995:Antitubercular Agents
keywords: Africa; Afrique; Care; Cost-minimisation; Model; cuidados; minimisation des coûts; minimización de costes; modelo; modèle; soins; África