Shift from in-patient to out-patient TB treatment in Ukraine

Objective: To demonstrate a cost effectiveness of tuberculosis (TB) case management out-patient model with directly observed treatment (DOT) versus long-term in-patient TB treatment widely implemented in Ukraine.

Methods: The 2014 study used retrospective expenditure analysis and patients’ adherence to DOT and treatment effectiveness in selected medical sites. Data sources were financial and medical records. Selected sites included the main TB facility and one primary health care (PHC) facility where TB patients were consistently provided with DOT. The study calculated and compared the cost per service: an out-patient DOT-service, a half-day stay, and a day in in-patient department. An intervention group of 37 TB patients who only underwent out-patient DOT, and a comparison group of 28 TB patients who received both in-patient and out-patient DOT, were analyzed. Both groups were identical regarding their diagnosis, condition, and absence of side effects.

Results: One out-patient DOT service in both TB and PHC facilities was three times cheaper than the half-day stay and 16 times cheaper than one day in the in-patient department. TB patients’ adherence to DOT and treatment effectiveness in the intervention group was 74 percent and 100 percent versus 54 percent and 83.9 percent in the comparison group. Thus, the out-patient TB case management model was more cost-effective.

Implications: The study became a catalyst for re-organizing TB medical services in the pilot region. The health authorities reduced the number of in-patient beds and increased the capability of half-day stay and out-patient TB and PHC facilities to provide DOT.