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Costs and outcomes of tuberculosis control in the Russian Federation: retrospective cohort analysis

Costs and outcomes of tuberculosis control in the Russian Federation: retrospective cohort analysis
Costs and outcomes of tuberculosis control in the Russian Federation: retrospective cohort analysis
We analysed costs and outcomes of tuberculosis care for patients in a traditional Russian tuberculosis control system, using 3-year retrospective cohort data. Of 1749 cases at 3 years of follow-up, 65% were cured, 11.3% (198/1749) still had 'active' or 'chronic' disease, 10.3% had transferred out of the local civilian health care system and 12.7% had died. The mean cost of managing one case over 3 years was 886 US dollars: 1,078 US dollars for bacteriologically confirmed (BK+) cases and 718 US dollars for bacteriologically unconfirmed (BK-) cases. Approximately 60% of treatment costs were incurred in the first 12 months and 40% incurred in the remaining 2 years. Around 60% of the total cost was accounted for by hospital inpatient care. The cost, treatment and outcome of BK+ and BK- cases differed substantially. The cost of treating BK+ cases was 50% higher than treating BK- cases due to higher hospitalization rates and the additional cost of managing BK+ cases that become 'chronic'. While BK+ cases accounted for 55% of total health expenditure on tuberculosis, the share of BK- cases was 45% of the total - due to hospitalization and lengthy periods of follow up. The costs of treating tuberculosis in the Russian tuberculosis control system are very high compared with other high-burden countries due to hospitalization policies and lengthy case management periods. Much of this expenditure can be avoided if the WHO-recommended DOTS strategy is implemented. In particular, the proportion of expenditure for BK- cases is surprisingly high and can be avoided as most of these patients do not need hospitalizing or lengthy periods of follow-up.
adult cohort studies, female health care costs, humans male, retrospective studies, russia/epidemiology treatment outcome, tuberculosis, classification, drug therapy, economics, epidemiology
0268-1080
353-364
Atun, R.A.
c9835b31-e234-4ff7-a383-1a4d8d635de6
Samyshkin, Y.
a62dbfff-0789-4279-af14-05a006728464
Drobniewski, F.
1b3af90f-5f68-4eb5-bf1f-cc5b89b8f7f5
Balabanova, Y.
c563ac4b-bfd6-4201-b134-564563da4d94
Fedorin, I.
e641af54-0398-4f57-9bd4-a13f62d658e0
Lord, J.
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Coker, R.J.
82d0d124-67e8-46a6-b8d4-37138b536967
Atun, R.A.
c9835b31-e234-4ff7-a383-1a4d8d635de6
Samyshkin, Y.
a62dbfff-0789-4279-af14-05a006728464
Drobniewski, F.
1b3af90f-5f68-4eb5-bf1f-cc5b89b8f7f5
Balabanova, Y.
c563ac4b-bfd6-4201-b134-564563da4d94
Fedorin, I.
e641af54-0398-4f57-9bd4-a13f62d658e0
Lord, J.
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Coker, R.J.
82d0d124-67e8-46a6-b8d4-37138b536967

Atun, R.A., Samyshkin, Y., Drobniewski, F., Balabanova, Y., Fedorin, I., Lord, J. and Coker, R.J. (2006) Costs and outcomes of tuberculosis control in the Russian Federation: retrospective cohort analysis. Health Policy and Planning, 21 (5), 353-364. (doi:10.1093/heapol/czl023). (PMID:16940301)

Record type: Article

Abstract

We analysed costs and outcomes of tuberculosis care for patients in a traditional Russian tuberculosis control system, using 3-year retrospective cohort data. Of 1749 cases at 3 years of follow-up, 65% were cured, 11.3% (198/1749) still had 'active' or 'chronic' disease, 10.3% had transferred out of the local civilian health care system and 12.7% had died. The mean cost of managing one case over 3 years was 886 US dollars: 1,078 US dollars for bacteriologically confirmed (BK+) cases and 718 US dollars for bacteriologically unconfirmed (BK-) cases. Approximately 60% of treatment costs were incurred in the first 12 months and 40% incurred in the remaining 2 years. Around 60% of the total cost was accounted for by hospital inpatient care. The cost, treatment and outcome of BK+ and BK- cases differed substantially. The cost of treating BK+ cases was 50% higher than treating BK- cases due to higher hospitalization rates and the additional cost of managing BK+ cases that become 'chronic'. While BK+ cases accounted for 55% of total health expenditure on tuberculosis, the share of BK- cases was 45% of the total - due to hospitalization and lengthy periods of follow up. The costs of treating tuberculosis in the Russian tuberculosis control system are very high compared with other high-burden countries due to hospitalization policies and lengthy case management periods. Much of this expenditure can be avoided if the WHO-recommended DOTS strategy is implemented. In particular, the proportion of expenditure for BK- cases is surprisingly high and can be avoided as most of these patients do not need hospitalizing or lengthy periods of follow-up.

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More information

Published date: 2006
Keywords: adult cohort studies, female health care costs, humans male, retrospective studies, russia/epidemiology treatment outcome, tuberculosis, classification, drug therapy, economics, epidemiology
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 382165
URI: http://eprints.soton.ac.uk/id/eprint/382165
ISSN: 0268-1080
PURE UUID: 0b558d54-5ede-43fe-8e47-1ef0040992cb
ORCID for J. Lord: ORCID iD orcid.org/0000-0003-1086-1624

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Date deposited: 26 Oct 2015 14:34
Last modified: 03 Dec 2019 01:33

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