Cost and cost-effectiveness of increased community and primary care facility involvement in tuberculosis care in Machakos District, Kenya

Abstract

To assess the cost and cost-effectiveness of new treatment strategies for tuberculosis patients, involving decentralisation of care from hospitals to peripheral health units and the community, compared to the conventional approaches to care used until October 1997. METHODS: Costs were analysed in 1998 US$ from the perspective of health services, patients, family members and the community, using standard methods. Separate analyses were undertaken for 1) new smear-positive pulmonary patients and 2) new smear-negative and extra-pulmonary patients. Cost-effectiveness was calculated as the cost per patient successfully completing treatment (smear-positive cases) and as the cost per patient completing treatment (new smear-negative and extra-pulmonary cases). There is a strong econ omic case for expansion of decentralisation and strengthened community¬based care in Kenya. The National Tuberculosis and Leprosy Control Programme will require new funds for start-up training and community mobilisation costs in order to do this.