ESTIMATING PROVIDER COST FOR TREATING PATIENTS WITH TUBERCULOSIS UNDER REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP)

摘要

Background: The Indian tuberculosis control programme is the second largest health programme in the world. Sustaining this programme in India will require continued financial support, particularly for drugs and contractual personnel. In addition, the costs for diagnosis, supervision and salaries for regular programme personnel need to be sustained.Objective: To measure unit provider cost for treating patients with tuberculosis.Methods: All government health facilities situated in one tuberculosis unit (TU) of Tiruvallur district were visited in order to evaluate daily practice of TB diagnosis and treatment. We interviewed administrators in these health facilities to gather data on modalities for diagnosis, treatment and monitoring of tuberculosis patients. In addition, relevant financial records from all health facilities were scrutinised for data collection. The cost analysis was done for diagnosis, treatment and monitoring of TB patients treated under DOTS programme in the year 2002 For this study only the recurrent cost (not the capital cost) is considered, even though the programme puts in a lot of investment at the preparatory stage of the programme e.g. upgrading of labs and drugs stores, microscopes, motorcycles etc. Cost incurred on smear microscopy, chest X-ray and drugs were classified as direct cost. Indirect cost is calculated based on proportion of staff time for TB care delivery and for supervision of TB services, The exchange rate at the time study was ldollar=Rs 46.Results: Unit cost for smear microscopy was estimated to be Rs 10/-; for radiography Rs 25/-; and drug cost for Category I Rs 392/-; Category I with extension Rs 495/-; Category II Rs 729/-; Category II with extension Rs 832/- and Category III Rs 277/-. Including other recurrent expenditures like salary, materials, and maintenance, the overall unit provider cost to treat a TB patient was Rs 1587/- for Category I, Rs 1924/- for Category II and Rs 1417/- Category III.Conclusion: TB inflicts considerable economic burden on the overall health system. This information is vital for policy makers and planners to allocate adequate budget to the programme.