Cost effectiveness : a comparative study of tuberculosis and multi drug resistance tuberculosis case management with health volunteer and health facility base model versus health facility base plus mobile phone communication by DOTS-Plus strategy in upper north of Thailand

Abstract

Backgrounds : Thailand has implemented of the Directly Observed Treatment Strategy to increase Tuberculosis control program efficacy but could not achieved key TB control program indicators as Indicated by WHO. Objectives : to compare the effectiveness of DOTS-plus strategy with mobile phone and DOTS-plus without mobile phone in upper north of Thailand. Methods : We conducted two TB control models with DOTS-plus strategy in MDR-TB and non MDR-TB group during April 2008 - April 2010 in upper-north Thailand as a control trial study. Model 1 was MDR- and non MDR-TB case management with health volunteer and health facility with DOTS-plus strategy.Model2 was MDR-TB and non MDR-TB case management with health facility with DOTS-plus strategy plus mobile phone. There were at least 19 patients in each arm of MUR-TB group and 30 patients in each arm of non MDR-TB group. We followed the patients 18 and 6 months for measuring the treatment outcomes of MDR-TB and non MDR-TB group. And cost effectiveness was calculated as the average cost per patient treated successfully. Results : The treatment outcome of Model 2 was effective than Model 2 with statistically significantly high success rate of 100% while Model 2 had success rate only 73.7% in MDR-TB group and also had high success rate of 100% while Model 1 had success rate in 96.7%.in non MDR-TB group (p=0.0001,p=0.047). And the total cost of managing a TB patient to treatment completion of model 2 was lower than Model 1 in both MDR-TB and non MDR-TB group. The higher cost was the cost of laboratory labor, volunteer payment and specimen transportation. It was high about 4.6 time of MDR-TB group and 2 time of non MDR-TB group. The CE ratio reflecting the cost benefits of both MDR-TB and non MDR-TB group in negative territory with CE ratio minus 14.6 in MDR-TB group and minus 5 in non MDR-TB group. Conclusions : In summary ,This paper describes our experiences with DOTS-Plus by mobile phone and the successful outcome suggests that DOTS-Plus by mobile phone is feasible ,affordable and cost effectiveness to extend application of process to area having high MDR TB rate.