ABSTRACT
The present study was undertaken to compare the efficacy, effectiveness and cost-effectiveness of three short-course regimens with a standard programme for treatment of new tuberculosis (TB) cases. The study was conducted by reviewing the results of TB treatment in 1642 newly diagnosed, sputum positive pulmonary TB patients with four drug regimens carried out in five zonal TB centres throughout Thailand in 1987-1989. Analysis showed that the three-short-course regimens were more cost-effective than the standard regimen from the perspective of both providers and patients. Among the three short-course programmes, isoniazid, rifampicin and pyrazinamide for 2 months, followed by isoniazid and rifampicin twice a week for 4 months was the most cost-effective (US$70.24/effectiveness from providers' perspective and US$103.31/effective from patients' perspective). The result of this study throws some light on the development of new policy options, with scarce health resources, in the treatment of tuberculosis by the National Tuberculosis Programme in Thailand.
Subject(s)
Antitubercular Agents/administration & dosage , Tuberculosis, Pulmonary/drug therapy , Adolescent , Adult , Antitubercular Agents/economics , Cost-Benefit Analysis , Drug Administration Schedule , Female , Humans , Isoniazid/administration & dosage , Male , Pyrazinamide/administration & dosage , Rifampin/administration & dosage , Thailand , Tuberculosis, Pulmonary/economicsABSTRACT
The standard regimen, a combination of isoniazid and thiacetazone, which has been used for treatment of tuberculosis (TB) in Thailand for the past 20 years is inexpensive, but possesses a high degree of toxicity and requires 18-24 months of continuous treatment, resulting in poor compliance and a low success rate of treatment. The more efficacious short-course chemotherapy introduced into the National Tuberculosis Program in 1985 is limited by the high costs of drugs. However, the cost of providing care is not limited only to drug costs but also includes other services costs. The present study was undertaken to compare the total provider costs of 3 short-course regimens with that of the standard program in the treatment of newly diagnosed pulmonary TB. Data were collected at 4 zonal TB centers through out Thailand in 1987-1988. Analysis showed that the 3 short-course regimens had lower costs than the standard regimen from the provider perspective. Among these 3 regimens that of isoniazid, rifampicin and pyrazinamide for 2 months, followed by isoniazid and rifampicin twice a week for 4 months had the lowest costs (Baht 1,499). Despite the lowest drug cost (B 431) of the standard regimen, the total provider costs were the highest (B 2,541) due to the highest routine service cost of B 2,066. Thus to determine the cost of a disease requires consideration of both drug costs and also other cost components.
Subject(s)
Antitubercular Agents/therapeutic use , Health Care Costs , Tuberculosis, Pulmonary/prevention & control , Ambulatory Care , Antitubercular Agents/administration & dosage , Antitubercular Agents/economics , Costs and Cost Analysis , Health Care Costs/statistics & numerical data , Humans , Patient Compliance , Thailand , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/economicsABSTRACT
Problems of tuberculosis treatment in Thailand are an obstacle in the national tuberculosis control programme. Reasons concerning the problems on the health provider side being the most important are the budget and the health personnel attitude and behavior, convenience of service, distance of service, health provider-consumer social relation, social support and health service quality. On the health consumer side are patient attitude and behavior and patient economy. The most important understanding to the problems is the socio-economic status of the nation and health providers are responsible for the problems.
