Abstract
This study was aimed at comparing the cost-effectiveness of tuberculosis treatment strategies between
community-based DOTS (Directly Observed Therapy, Short Course) and hospital care at Maesai
Hospital, Chiang Rai Province. Data on costs were collected in terms of provider and patient perspectives.
Cost-effectiveness was calculated as the cost per patient successfully treated. The nine-month historical
cohort study from November 1, 2009 to July 31, 2010 was designed to measure outcomes of tuberculosis treatment. By matching new pulmonary tuberculosis patients aged 15 to 60 years, the study included
54 patients from community-based DOTS programs and 52 patients receiving hospital care. The
hospital cases were divided into three groups, i.e. days since admission: 1 to 7; 8 to 14; and more than 14,
totalling 38, 8 and 6 patients, respectively. The provider cost data were collected from medical records
while the patient cost data were collected in face-to-face interviews.
Results showed that the average tuberculosis treatment costs under community-based DOTS Programs
and hospital care were 9,436.84 baht and 13,540.32 baht per patient, respectively. Communitybased
DOTS reduced costs by 30.31 per cent in comparison with hospital care. Sub-group cost analysis of
hospital care of 1 to 7, 8 to 14 and more than 14 days since admission showed costs of 10,051.97, 19,168.63
and 27,969.72 baht per patient, respectively. The clinical success rates of community-based DOTS and
hospital care were 90.74 per cent and 94.23 per cent respectively. The incremental costs of a case successfully
treated in hospital were 1,175.78 baht higher than that of a community-based DOTS program.
The study suggested that community-based DOTS is a more economically attractive option than
hospital care. This is particularly important in settings where a TB clinic is implemented under the
limited resources available to Maesai Hospital.
