Costs and outcomes of tuberculosis control in the Russian Federation: retrospective cohort analysis
1Centre for Health Management, Tanaka Business School, Imperial College London, London, UK, 2HPA Mycobacterium Reference Unit, Clinical TB and HIV Group, St Bartholomew and Queen Mary School of Medicine, London, UK, 3Samara Ministry of Health, Samara, Russia, 4National Institute for Clinical Excellence, London, UK and 5Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
Correspondence: Dr Rifat A Atun, Centre for Health Management, Tanaka Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK. Tel: +44 (0) 20 7594 9160; Fax: +44 (0) 20 7823 7685; E-mail: r.atun{at}imperial.ac.uk
We analysed costs and outcomes of tuberculosis care for patients in a traditional Russian tuberculosis control system, using 3-year retrospective cohort data. Of 1749 cases at 3 years of follow-up, 65% were cured, 11.3% (198/1749) still had ‘active’ or ‘chronic’ disease, 10.3% had transferred out of the local civilian health care system and 12.7% had died. The mean cost of managing one case over 3 years was US$886: US$1078 for bacteriologically confirmed (BK+) cases and US$718 for bacteriologically unconfirmed (BK–) cases. Approximately 60% of treatment costs were incurred in the first 12 months and 40% incurred in the remaining 2 years. Around 60% of the total cost was accounted for by hospital inpatient care.
The cost, treatment and outcome of BK+ and BK– cases differed substantially. The cost of treating BK+ cases was 50% higher than treating BK– cases due to higher hospitalization rates and the additional cost of managing BK+ cases that become ‘chronic’. While BK+ cases accounted for 55% of total health expenditure on tuberculosis, the share of BK– cases was 45% of the total – due to hospitalization and lengthy periods of follow up.
The costs of treating tuberculosis in the Russian tuberculosis control system are very high compared with other high-burden countries due to hospitalization policies and lengthy case management periods. Much of this expenditure can be avoided if the WHO-recommended DOTS strategy is implemented. In particular, the proportion of expenditure for BK– cases is surprisingly high and can be avoided as most of these patients do not need hospitalizing or lengthy periods of follow-up.
Key Words: tuberculosis, health systems, Russian Federation, economic evaluation