Cost and cost-effectiveness of community-based care for tuberculosis patients in rural Uganda.

SETTING: Kiboga district, a rural area in Central Uganda.
OBJECTIVE: To assess the cost and cost-effectiveness of community-based care for new smear-positive pulmonary tuberculosis patients compared with conventional hospital-based care.
METHODS: Costs were analysed from the perspective of health services, patients, and community volunteers in 1998 US dollars, using standard methods. Cost-effectiveness was calculated as the cost per patient successfully treated.
FINDINGS: The cost per patient treated for new smear-positive patients was dollars 510 with the conventional hospital-based approach to care (dollars 419 for the health system and dollars 91 for patients), and dollars 289 with community-based care (dollars 227 for health services, dollars 53 for patients and dollars 9 for volunteers). Important new costs associated with community-based care included programme supervision (dollars 18 and dollars 9 per patient at central and district levels, respectively) and training (dollars 18 per patient). The cost per patient successfully treated was dollars 911 with the hospital-based strategy and dollars 391 with community-based care, reflecting both lower costs and higher effectiveness (74% vs. 56% successful treatment rate) with community-based care. Length of hospital stay fell from an average of 60 to 19 days.
CONCLUSION: There is a strong economic case for the implementation of community-based care in Uganda.