Cost and cost-effectiveness of smear-positive tuberculosis treatment by Health Extension Workers in Southern Ethiopia: a community randomized trial

Daniel G Datiko, Bernt Lindtjørn, Daniel G Datiko, Bernt Lindtjørn

Abstract

Treatments by HEWs in the health posts and general health workers at health facility were compared along a community-randomized trial. Costs were analysed from societal perspective in 2007 in US $ using standard methods. We prospectively enrolled smear positive patients, and calculated cost-effectiveness as the cost per patient successfully treated. The total cost for each successfully treated smear-positive patient was higher in health facility ($158.9) compared with community ($61.7). Community-based treatment reduced the total, patient and caregiver cost by 61.2%, 68.1% and 79.8%, respectively. Involving HEWs added a total cost of $8.80 (14.3% of total cost) on health service per patient treated in the community.

Conclusions/significance: Community-based treatment by HEWs costs only 39% of what treatment by general health workers costs for similar outcomes. Involving HEWs in TB treatment is a cost effective treatment alternative to the health service, to the patients and the family. There is an economic and public health reason to consider involving HEWs in TB treatment in Ethiopia. However, community-based treatment requires initial investment to start its implementation, training and supervision.

Trial registration: ClinicalTrials.gov NCT00803322.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Tuberculosis patient costs under DOT…
Figure 1. Tuberculosis patient costs under DOT options.
Blue bar - Health facility DOT. Red bar - Community DOT.
Figure 2. Caregiver costs under DOT options.
Figure 2. Caregiver costs under DOT options.
Blue bar - Health facility DOT. Red bar - Community DOT.
Figure 3. Costs per successfully treated smear-positive…
Figure 3. Costs per successfully treated smear-positive tuberculosis patient.
Blue bar - Health facility DOT. Red bar - Community DOT.

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