Directly observed treatment of tuberculosis: direct medical costs for the Brazilian health system

Supplement : Abstracts of the 2016 International Symposium on HIV and Emerging Infectious Diseases (ISHEID)

Journal of Virus Eradication 2016; 2 supplement 1

Abstract No : P95


Michela Prestes Gomes, Nathalia Halax Orfão, Aline Ale Beraldo, Aldaísa Cassanho Forster, Claudia Souza Passador, Maria Eulália Lessa Do Valle Dallora, Antonio Ruffino Netto

University of Sao Paulo, Faculty of Medicine of Ribeirão Preto, Sao Paulo, Brazil

Abstract :

Tuberculosis (TB) is very common and prevalent in Brazil. The estimate of costs was used due to the need to carry out research related to economic assessment in the Brazilian health system.

Objective: To estimate direct medical costs for the treatment of TB in the public health system, addressing the strategies of directly observed treatment (DOT) and self-managed treatment (SMT).

Methods: This is a descriptive, epidemiological and analytical study, based on survey and cost estimates. The convenience sampling included all the patients registered in the period from 2010 to 2012 in the Health Center of Ribeirão Preto Medical School, University of São Paulo (USP), Brazil. The data were obtained from: a) medical files (medication, exams and visits); b) interviews with health professionals of the Tuberculosis Control Program (TCP) (physicians, nurses, nursing assistants); c) interviews with professionals who monitored the medication use in the patients’ homes (drivers, sanitary visitors), including the resources used to make feasible the visit for the DOT (fuel).

Results: Table P95.1 shows the distributed costs for both treatment strategies – DOT and SMT. Patients in the DOT strategy resulted in an average cost of US$ 572.61, and those in the SMT strategy in US$ 360.26 since the beginning of the treatment and follow-up of the disease until the discharge. The rate of treatment interruption for the patients in DOT situation was very similar to the rate for patients in SMT situation, that is, 0.82 and 0.87, respectively. The estimated ratio between the costs and the end of treatment/cure was US$ 701.73 to treat one case in DOT strategy, and US$ 411.72 to treat one case in SMT strategy.

Conclusion: Monitoring the intake of TB medication carried out at the patients’ homes in DOT strategy generates high costs for the health system; however, whether this treatment strategy is cost-effective depends on additional studies of health technology assessment.

Distribution of direct medical costs (US$*) (data from medical files and interviews with health professionals of TCP), CSE-FMRP-USP, Ribeirão Preto, São Paulo

DOT (n=42) SMT (n=17)
n Average Standard Deviation n Average Standard Deviation
Treatment of TB
Exams 42 71.85 69.94 17 61.17 41.60
Medication 41 64.09 46.93 16 55.40 13.46
Subtotal 42 134.42 93.96 16 120.39 45.56
Fuel 40 57.78 20.97
Driver 40 238.03 86.37
Sanitary Visitor 40 139.42 50.59
Subtotal 40 435.23 157.93
Professionals of TCP (Physician/Nurse/Nursing Assistant) 42 733.72 307.93 17 693.68 139.23
TOTAL COST 42 1282.65 496.30 17 806.98 175.85

exchange rate US$ 1.00 = R$2.24

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