Cost savings from alternative treatments for tuberculosis

The cost effectiveness of short tuberculosis treatment regimes using rifampicin (R) or thambutol (E) is calculated and compared to long regimes based on thiacetazone and isoniazid (TH). Although rifampicin and ethambutol are more costly per case they are only about one half the cost of the isoniazid based regimes per person effectively treated. This result is primarily derived from higher patient compliance with the short regimes. In addition, ambulatory treatment, where practical, is approximately one third the cost per person effectively treated of regimes using inpatient treatment for the first 2 months. Applied to 1982 data for Botswana, the analysis reveals that treating 80% of patients through ambulatory R and E regimes would have reduced total health expenditures for tuberculosis care by two thirds compared to inpatient regimes based on TH, and the number of people complying and cured would have doubled.