Costs and Benefits of Improving Tuberculosis Control: The Case of Thailand
Holger Sawert*, Mario C. Raviglione, Pasakorn Akarasewi, Paul P. Nunn, สุคนธา คงศีล, Vallop Payanandana
Central Chest Clinic, Tuberculosis Division, Ministry of Public Health, 611 Bamrungmuang Road, Bangkok 10100, Thailand.
The study evaluates the economic costs and benefits of improving tuberculosis control interventions in Thailand. Provider costs are determined on the basis of marginal treatment costs for varying case numbers and estimates of the cost of required infrastructure changes. Indirect costs are calculated as income lost due to morbidity and premature mortality. An epidemiological model is used to calculate case numbers and mortality under current control conditions and a scenario of improved control. An improved control strategy initially leads to a higher number of detected cases. For longerprojection periods, the epidemiological impact of curing a higher proportion of infectious sources results in lower case numbers than those expected without programme improvement. Model simulations show a reduction of total annual case numbers through improved control measures by an average 45% after a simulation period of 20 years. The corresponding societal savings in form of reduced indirect costs from the disease are U.S.$2.4 billion. Reductions in direct provider costs can be expected as a result of decreased numbers of detected cases for longer evaluation periods, as well as a lower proportion of multi-drug-resistant cases. The mean value of predicted savings is U.S.$8.3 million. Since this value is likely to be higher than the required investment in improved infrastructure, net savings can be expected. The result of an uncertainty analysis shows a wide range of potential additional costs or net savings with respect to direct provider costs. Indirect cost calculations show net savings for all parameter values.
Social Science and Medicine ปี 2540, June ปีที่: 44 ฉบับที่ 12 หน้า 1805-1816