Shifting the balance between in-patient and out-patient care for tuberculosis results in economic savings

SETTING: Although hospitalisation is not always necessary for the treatment of tuberculosis (TB), in Australia 90% of TB patients have treatment initi ated in hospital. OBJECTIVE: To calculate and compare the costs of inpatient and out-patient tuberculosis treatment, and to measure the impact of shifting care from in- patient to outpatient settings. METHODS: In a costing study performed in Victoria, Australia, the proportio n of all notified TB cases who were hospitalised was calculated by matching coded state hospital morbidity data with the Victoria Notifiable Diseases database for the financial year 1994-1995. In-patient and out-patient costs were calculated using data obtained from a number of sources. The effect o n health care costs of varying the proportion of TB cases treated as in-pat ients and out-patients was calculated using Excel. RESULTS: Nearly 90% (239/269) of notified TB cases received hospitalised ca re in 1994-1995, The cost of treatment for hospitalised patients (mean leng th of stay 2 weeks) was AU$5447 per patient, with a total cost of $1301833. Hospitalisation comprised 60% of the total cost of treatment. The cost of out-patient treatment was $2260 per patient. If 90% of patients were treate d on an out-patient basis, the total cost would be $693670. We estimated th at it would be feasible to treat at least 55% of TB patients as out-patient s, reducing costs by nearly 30%. CONCLUSIONS: Routine hospitalisation for patients with uncomplicated TB is not necessary, but is often used in industrialised countries. More cost-eff ective use of resources can be achieved by giving initial TB treatment on a n out-patient basis rather than in hospital for a greater proportion of cas es.