Cost and cost-effectiveness of community-based care for tuberculosis patients in rural Uganda

Kiboga district, a rural area in Central Uganda. To assess the cost and cost-effectiveness of community-based care for new smear-positive pulmonary tuberculosis patients compared with conventional hospital-based care. Costs were analysed from the perspective of health services, patients, and community volunteers in 1998 US$, using standard methods. Cost-effectiveness was calculated as the cost per patient successfully treated. The cost per patient treated for new smear-positive patients was $510 with the conventional hospital-based approach to care ($419 for the health system and $91 for patients), and $289 with community-based care ($227 for health services, $53 for patients and $9 for volunteers). Important new costs associated with community-based care included programme supervision ($18 and $9 per patient at central and district levels, respectively) and training ($18 per patient). The cost per patient successfully treated was $911 with the hospital-based strategy and $391 with community-based care, reflecting both lower costs and higher effectiveness (74% vs. 56% successful treatment rate) with community-based care. Length of hospital stay fell from an average of 60 to 19 days. There is a strong economic case for the implementation of community-based care in Uganda.