Cost-effectiveness of community health worker versus home-based guardians for directly observed treatment of tuberculosis in Vitória, Espírito Santo State, Brazil
Identifieur interne : 001D75 ( Pmc/Curation ); précédent : 001D74; suivant : 001D76Cost-effectiveness of community health worker versus home-based guardians for directly observed treatment of tuberculosis in Vitória, Espírito Santo State, Brazil
Auteurs : Thiago Nascimento Do Prado [Brésil] ; Nikolas Wada [États-Unis] ; Leticia Molino Guidoni [Brésil] ; Jonathan E. Golub [États-Unis] ; Reynaldo Dietze [Brésil] ; Ethel Leonor Noia Maciel [Brésil]Source :
- Cadernos de saude publica [ 0102-311X ] ; 2011.
Abstract
The objective of this study was to compare the costs and outcomes associated with guardian-supervised directly observed treatment relative to the standard of care Directly Observed Therapy, Short Course (DOTS) provided by community health workers (CHW). New cases of culture-positive pulmonary tuberculosis (TB) treated in Vitória, Espírito Santo State, Brazil, between January 2005 and December 2006 were interviewed and chose their preferred treatment strategy. Costs incurred by providers and patients (and patients’ families) were estimated, and cost-effectiveness was assessed by comparing costs per successfully treated patient. 130 patients were included in the study; 84 chose CHW-supervised DOTS and 46 chose guardian-supervised DOTS. 45 of 46 (98%) patients treated with guardian-supervised DOTS were cured or completed treatment compared to 70/84 (83%) of the CHW-supervised patients (p = 0.01). Logistic regression showed only the strategy of supervision to be a significant association with treatment outcome, with guardian-supervised care strongly protective. Cost per patient treated with guardian-supervised DOTS was US$398, compared to US$548 for CHW-supervised DOTS. The guardian-supervised DOTS is an attractive option to complement CHW-supervised DOTS.
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PubMed: 21655845
PubMed Central: 3713773
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New cases of culture-positive pulmonary tuberculosis (TB) treated in Vitória, Espírito Santo State, Brazil, between January 2005 and December 2006 were interviewed and chose their preferred treatment strategy. Costs incurred by providers and patients (and patients’ families) were estimated, and cost-effectiveness was assessed by comparing costs per successfully treated patient. 130 patients were included in the study; 84 chose CHW-supervised DOTS and 46 chose guardian-supervised DOTS. 45 of 46 (98%) patients treated with guardian-supervised DOTS were cured or completed treatment compared to 70/84 (83%) of the CHW-supervised patients (p = 0.01). Logistic regression showed only the strategy of supervision to be a significant association with treatment outcome, with guardian-supervised care strongly protective. Cost per patient treated with guardian-supervised DOTS was US$398, compared to US$548 for CHW-supervised DOTS. The guardian-supervised DOTS is an attractive option to complement CHW-supervised DOTS.</p></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
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<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8901573</journal-id><journal-id journal-id-type="pubmed-jr-id">20991</journal-id><journal-id journal-id-type="nlm-ta">Cad Saude Publica</journal-id><journal-id journal-id-type="iso-abbrev">Cad Saude Publica</journal-id><journal-title-group><journal-title>Cadernos de saude publica</journal-title></journal-title-group><issn pub-type="ppub">0102-311X</issn><issn pub-type="epub">1678-4464</issn></journal-meta><article-meta><article-id pub-id-type="pmid">21655845</article-id><article-id pub-id-type="pmc">3713773</article-id><article-id pub-id-type="manuscript">NIHMS488365</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Cost-effectiveness of community health worker versus home-based guardians for directly observed treatment of tuberculosis in Vitória, Espírito Santo State, Brazil</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>do Prado</surname><given-names>Thiago Nascimento</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Wada</surname><given-names>Nikolas</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Guidoni</surname><given-names>Leticia Molino</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Golub</surname><given-names>Jonathan E.</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Dietze</surname><given-names>Reynaldo</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Maciel</surname><given-names>Ethel Leonor Noia</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>Universidade Federal do Espírito Santo, Vitória, Brasil</aff><aff id="A2"><label>2</label>Johns Hopkins University, Baltimore, USA</aff><author-notes><corresp id="FN1">Correspondence: T. N. Prado, Laboratório de Epidemiologia, Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo.Av. Marechal Campos 1468, Vitória, ES 29040-091, Brasil. <email>tiagufes@yahoo.com.br</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>26</day><month>6</month><year>2013</year></pub-date><pub-date pub-type="ppub"><month>5</month><year>2011</year></pub-date><pub-date pub-type="pmc-release"><day>17</day><month>7</month><year>2013</year></pub-date><volume>27</volume><issue>5</issue><fpage>944</fpage><lpage>952</lpage><abstract><p id="P1">The objective of this study was to compare the costs and outcomes associated with guardian-supervised directly observed treatment relative to the standard of care Directly Observed Therapy, Short Course (DOTS) provided by community health workers (CHW). New cases of culture-positive pulmonary tuberculosis (TB) treated in Vitória, Espírito Santo State, Brazil, between January 2005 and December 2006 were interviewed and chose their preferred treatment strategy. Costs incurred by providers and patients (and patients’ families) were estimated, and cost-effectiveness was assessed by comparing costs per successfully treated patient. 130 patients were included in the study; 84 chose CHW-supervised DOTS and 46 chose guardian-supervised DOTS. 45 of 46 (98%) patients treated with guardian-supervised DOTS were cured or completed treatment compared to 70/84 (83%) of the CHW-supervised patients (p = 0.01). Logistic regression showed only the strategy of supervision to be a significant association with treatment outcome, with guardian-supervised care strongly protective. Cost per patient treated with guardian-supervised DOTS was US$398, compared to US$548 for CHW-supervised DOTS. The guardian-supervised DOTS is an attractive option to complement CHW-supervised DOTS.</p></abstract><kwd-group><kwd>Tuberculosis</kwd><kwd>Cost-Benefit Analysis</kwd><kwd>Effectiveness</kwd></kwd-group><funding-group><award-group><funding-source country="United States">Fogarty International Center : FIC</funding-source><award-id>U2R TW006885 || TW</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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