Understanding Current and Future Direct Costs of Delivering Tuberculosis Treatment Services in Low Resource Settings

Presenter: Hong Wang, Abt Associates, Inc.

Abstract

Background:
Global efforts to control TB have been reinvigorated over the last decade. TB control demands a comprehensive and sustained response by national and international partners. The complexity of the resource estimation issue makes it difficult for overburdened planners in low technical capacity settings to calculate direct costs on a continuous basis.

To assist with planning effective national programs, a costing model has been developed by Health Systems 20/20 project. The model looks at current treatment outcomes of a national TB-DOTS program with the resources required to support existing and future caseloads. The model simulates treatment cohorts and accounts for cured, relapse, default, and retreatment issues. The unit costs factor in different DOTS regimens and prices for intensive vs. continuation phases, for new registrations vs. retreatment, and adult vs. pediatric cases. In addition, direct costs of inpatient care and second-line regimens if MDR-TB is present, as well as for TB-HIV program coordination are included. Health worker time required to diagnose, prescribe, and monitor drug intake is also estimated.

Design/Methods:

The software model uses treatment outcomes data from each state in Nigeria and estimates the financial and human resources required for the program for 2008-2013. A treatment cohort is simulated for each of Nigeria’s 37 states, allowing DOTS clients across three categories (new cases, retreatment, adult/pediatric) to move across treatment states. The user can modify the basic unit costs and set treatment regimens for time and drugs used (and prices). Data from a time-motion study of Nigerian DOTS facilities is used to estimate health workers needed over time, and salary data from public health facilities is used to generate associated payroll costs.

Results/Outcome:
The software displays results of the costing of the TB program graphically and in tabular format for easy use in documents and slides. The model projected Nigeria’s total direct costs of the DOTS, MDR-TB, and TB-HIV program, with a basic scenario for the increase in TB caseload, at US$19 million in 2012. Of this, US$14.3 million was spent on DOTS services (from all sources, including referrals from the HIV program) and TB inpatient care, US$3.8 million on MDR-TB services, and $0.9 million on CPT/ART for TB-HIV co-infections.

Conclusions:
The easy-to-use costing model allows TB planners to get realistic values for the total cost of a national TB treatment and control program, gauge program sustainability, and advocate for appropriate resource allocation. It avoids the need to depend on fixed costs over time, and yields the human resource intensity of the program over time.

Partners: WHO/Nigeria, especially Dr Philip Patrobas.

Co-Authors: None