COSTS AND COST-EFFECTIVENESS OF ALTERNATIVE TUBERCULOSIS MANAGEMENT STRATEGIES IN SOUTH-AFRICA - IMPLICATIONS FOR POLICY

Objective. To conduct an economic analysis of the Hlabisa community-ba sed directly observed therapy management strategy for tuberculosis and to project costs of three alternative strategies. Setting. Hlabisa he alth district, KwaZulu-Natal, South Africa. Methods. An economic analy sis comparing the current tuberculosis management strategy in Hlabisa with three alternative strategies (the Hlabisa strategy prior to 1991 based on hospitalisation, the national strategy and sanatorium care) i n terms of costs to both health service and patient and of cost-effect iveness. Results. The current Hlabisa strategy was the most cost-effec tive (R3 799 per patient cured), compared with R98 307 for the strateg y used prior to 1991, R9 940 for the national strategy, and R11 145 fo r sanatorium care, Between 71% and 88% of treatment costs lie with the health service, and hospitalisation (R119 per day) is the most expens ive item. Prolonged hospitalisation is extremely expensive, but commun ity care is cheaper (community clinic visit, R28; community health wor ker visit, R7). The total cost of supervising a patient in the communi ty under the current Hlabisa strategy was R503, equivalent to 4.2 days in hospital, Drug costs (R157) are equivalent to just 1.3 days in hos pital. Conclusion. Cost to both health service and patient can be subs tantially reduced by using community-based directly observed therapy f or tuberculosis, a strategy that is cheap and cost-effective in Hlabis a, These findings have important national implications, supporting the goals of the new tuberculosis control programme.