[The cost of tuberculosis care: in-patient estimated costs]

Abstract

Objective: To calculate the costs of in hospital tuberculosis treatment and to compare the estimated charges of multidrug-resistant tuberculosis (MDR-TB) and drug susceptible tuberculosis patients (TB).

Design: Descriptive study.

Setting: Tuberculosis Unit (Pulido Valente Hospital), Lisbon, Portugal.

Methods: The records of all TB patients discharged between January and December 2000 were reviewed. The cost analysis was conducted by using the hospital cost accounting system data and the charges approved by the national public health system. The main outcome measures were the following costs: 1) laboratory and ancillary services, 2) medication and 3) other direct and indirect components.

Results: The 116 study patients were divided into 3 groups: HIV/TB-48 (41.4%), TB 62 (53.4%) and MDR-TB-6 (5.2%). The estimated cost of treatment for all patients was PTE 213,732.769, but only 42% was covered by diagnosis-related groups financing system. In the MDR-TB group, the median cost per day (PTE 7,531) and the median cost per episode (PTE 316,593) were significantly higher comparing with the TB group, regarding laboratory services and medication items.

Conclusions: The hospital care budget based on the diagnosis-related groups financing system, accounted for less than half the estimated costs of tuberculosis in-patients. Also, in regarding tuberculosis the diagnosis-related groups system does not account for a major confounder like MDR-TB, which has an huge impact on the length of hospital stay and increasing laboratory and medication costs.