COST-EFFECTIVENESS ANALYSIS OF TUBERCULOSIS TREATMENT UNDER THE DOTS STRATEGY AT DIFFERENT LEVELS OF HOSPITALS IN BHUTAN

Abstract

This is a descriptive study that looks at cost and TB treatment outcome as per DOTS strategy across three levels hospital from the provider perspective. Study provides unit and total cost of providing DOTS and cost-effectiveness ratio (CER) in terms of cost per patient treatment successful (patient who was cured or who completed treatment).

Retrospective treatment outcome and cost data were collected from the four hospitals for one fiscal year. Cost of treatment was estimated using activity based costing method. CER is calculated among treatment category I. Total cost of providing of DOTS is Nu 3,100,817 (USD 56,378) with treatment success rate of 92% at National Referral Hospital and CER is Nu 12,305 (USD 224) and cost per DOTS is Nu 10,729 (USD 195). Regional Referral Hospital has treatment success rate of 88% and total cost of DOTS is Nu 1,369,736 (USD 24,904). CER is Nu 15,744 (USD 286) and average cost per DOTS is Nu 13,045 (USD 237). Between two District Hospitals, it was found that District Hospital which usually report more cases of TB annually has total cost of Nu 539,521 (USD 9,809) with treatment success of 100% and CER is Nu 22,480 (USD 409) and cost per DOTS is Nu 15,415 (USD 280). District Hospital reporting low TB case has treatment success of 93% with total cost of Nu 468,920 (USD 8,526) and CER is Nu 16,747 (USD 304) and cost per DOTS is Nu 15,631 (USD 284).

This study finding would provide MoH and stakeholders with a baseline to allocate resources for DOTS implementation and also to explore the cost-effectiveness of other program initiatives in a free health care system for reasons of sustainability.