Background
Methods
Costs | Notes | Identification method | Source of data |
---|---|---|---|
Health Systems costs
| |||
Staff salaries | Includes only the proportion of annual salary of staff attributable to TB | Salary rate for this category of staff (net salary per day) × annual days attributable to TB | Facility financial records Semi-structured questionnaire |
Training | Includes monitoring and supervision | Cost of training for this intervention as a proportion of the total cost of training for each facility number of training courses in the study sites (for regional level) | Facility records Semi-structured questionnaire |
Medicines | NTP estimates of medicine costs per patient × Total number of patients in the study sites | Tuberculosis Control in Nepal 2055–2060 (1998–2003), Long Term Plan; Annual Report of TB Control Program Nepal, 2058/2059 (2001/2002) Facility records (for No of patients) | |
Transportation | Includes transportation of medicines and laboratory supplies. | Total cost of transportation | Facility records |
Utilities | Total cost of utilities × time for TB programme (e.g. 1/3 for regional level) | Facility records Semi-structured questionnaire | |
Others | Includes supplies, logistics, social mobilisation through DOTS committees | Facility records Semi-structured questionnaire | |
Social costs
| |||
Direct costs | Includes treatment and travel charges | Number of visits × travel and consultation charges | Semi-structured questionnaire |
Opportunity costs | Includes costs for time lost due to involvement in the scheme | Standardised daily rate for unskilled labour (NRs 85/day) × time lost due to involvement in the scheme | Semi-structured questionnaire |
Other costs | Includes miscellaneous expenses such as refreshments while in the treatment centre | Patients and supervisors' recollection of any other expenses | Semi-structured questionnaire |
Districts using community-based DOTS strategy | Districts using family-based DOTS strategy | ||||||
---|---|---|---|---|---|---|---|
Palpa | Syangja | Doti |
Total*
| Baglung | Dolakha |
Total
| |
Total no of patients treated, including: | 422 | 335 | 125 |
460
| 136 | 117 |
253
|
No of patients successfully treated | 367 | 276 | 106 |
382
| 104 | 104 |
208
|
Results
Districts using the community-based DOTS strategy | Districts using the family-based DOTS strategy | ||||||
---|---|---|---|---|---|---|---|
Palpa | Syangja | Doti |
Total*
| Baglung | Dolakha |
Total
| |
Total number of patients treated | 422 | 335 | 125 |
460
| 136 | 117 |
253
|
No of patients successfully treated | 367 | 276 | 106 |
382
| 104 | 104 |
208
|
Treatment success rate |
87%
| 82% | 85% |
83%
| 76% | 89% |
82%
|
Costs per patient
| |||||||
Total recurrent costs, including: |
65.7
| 71.4 | 89.3 |
76.2
| 85.4 | 82.5 |
84.1
|
Recurrent cost to health system |
42.0
| 42.7 | 62.5 |
48.1
| 59.2 | 48.6 |
54.3
|
Personnel costs
|
19.9
|
21.5
|
35.6
|
25.3
|
26.6
|
23.9
|
25.3
|
Drug costs
|
12.5
|
12.1
|
12.9
|
12.3
|
13.0
|
12.9
|
13.0
|
Transportation
|
0.9
|
1.1
|
6.8
|
2.7
|
5.1
|
3.2
|
4.2
|
Utilities
|
3.7
|
4.6
|
2.8
|
4.1
|
6.3
|
5.3
|
5.9
|
Training, supervision, monitoring
|
1.6
|
1.8
|
4.0
|
2.4
|
2.3
|
1.9
|
2.1
|
Others (supplies, logistics, social mobilisation)
|
3.5
|
1.6
|
0.5
|
1.3
|
5.9
|
1.4
|
3.8
|
Recurrent cost to patients and supervisors |
23.6
| 28.6 | 26.8 |
28.1
| 26.2 | 34.0 |
29.8
|
Total costs to patients: |
20.7
| 25.2 | 24.4 |
25.0
| 21.6 | 19.2 |
20.5
|
Opportunity costs
|
13.4
|
12.5
|
9.2
|
11.6
|
13.4
|
19.2
|
16.1
|
Direct costs
|
5.1
|
6.9
|
8.6
|
7.3
|
8.2
|
0.0
|
4.4
|
Other costs
|
2.2
|
5.8
|
6.6
|
6.1
|
0.0
|
0.0
|
0.0
|
Total costs to supervisors, including: |
3.0
| 3.4 | 2.3 |
3.1
| 4.6 | 14.7 |
9.3
|
Opportunity costs
|
3.0
|
2.3
|
2.3
|
2.3
|
2.8
|
13.6
|
7.8
|
Direct costs
|
0.0
|
1.1
|
0.0
|
0.8
|
2.5
|
0.2
|
1.4
|
Districts using the community-based DOTS strategy | Districts using the family-based DOTS strategy | ||||||
---|---|---|---|---|---|---|---|
Level | Palpa | Syangja | Doti |
Total*
| Baglung | Dolakha |
Total
|
Total, including | 17,740.8 | 14,320.1 | 7,817.0 | 22,137.1 | 8,045.2 | 5,684.3 | 13,729.5 |
National
| 8,894.3 | 7,655.1 | 2,583.2 | 10,238.3 | 3,590.2 | 2,623.3 | 6,213.6 |
Regional
| 2,433.7 | 2,433.7 | 1,002.5 | 3,436.1 | 1,223.2 | 22.8 | 1,246.0 |
District
| 1,926.7 | 1,573.7 | 1,940.4 | 3,514.0 | 2,551.6 | 1,781.2 | 4,332.7 |
Treatment centre
| 3,904.7 | 1,324.8 | 1,149.7 | 2,474.5 | 431.1 | 903.0 | 1,334.1 |
Treatment sub-centre
| 581.4 | 1,332.8 | 1,141.3 | 2,474.2 | 249.0 | 354.0 | 603.0 |
Community-based DOTS strategy | Family-based DOTS strategy | ||||||
---|---|---|---|---|---|---|---|
Palpa | Syangja | Doti |
Total*
| Baglung | Dolakha |
Total
| |
Recurrent costs per treatment succeeded, including |
75.5
| 86.6 | 105.3 |
91.8
| 111.6 | 92.9 |
102.2
|
Total recurrent cost to health system per treatment succeeded |
48.3
| 51.9 | 73.7 |
58.0
| 77.4 | 54.7 |
66.0
|
Total recurrent social costs (patients + supervisors) per treatment succeeded including: |
27.2
| 34.7 | 31.6 |
33.9
| 34.3 | 38.2 |
36.2
|
Total costs to patients per treatment succeeded
|
23.8
|
30.6
|
28.8
|
30.1
|
28.3
|
21.7
|
25.0
|
Total costs to supervisors per treatment succeeded
|
3.4
|
4.1
|
2.7
|
3.7
|
6.0
|
16.5
|
11.3
|
Discussion
-
social acceptability of particular initiatives, e.g. willingness of patients to overcome possible cultural barriers in approaching a community member in order to request supervision of DOTS;
-
availability of community member supervisors, as well as their attitude and willingness to monitor the treatment of TB patients;
-
availability of robust supply and logistics mechanisms within the health system to ensure timely and continuous provision of DOTS medicines to patients/treatment supervisors;
-
other health system- and social-related issues that are pertinent to different contexts such as the degree of decentralisation, or cultural norms which may facilitate or inhibit the implementation of decentralised DOTS schemes.