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目的:结核病的治疗不仅时间长、费用高,而且常常由于病人依从性不好使得治疗复杂化。直接面视下治疗(DOT),这个门诊治疗管理策略就是为了保证病人的依从性。但该策略并未得以广泛推行,因为感觉实施该策略的成本很高。本研究旨在比较DOT和传统治疗在治疗结核病中的治疗成本。设计:对某都市的县卫生局1980年到1994年间659名结核病报告病例进行回顾性经济学评估。按照1995年的美元价格估计门诊治疗成本、住院治疗成本以及复发和获得性耐药病例对治疗成本的影响。结果:DOT的治疗成本较低:每例住院治疗病人的治疗成本为＄15 670,每例门诊治疗病人的治疗成本为＄700(P<0.001)。这种治疗成本的差异是由于治疗时间不同(334天对550天)、住院次数减少(58%对75%)以及住院时间短(每例住院病人26天对55天)造成的。在传统治疗组复发或获得性耐药的发生率为10.9％,这些复发或获得性耐药病例所使用的治疗成本占总治疗成本中的35.7%,而在直接面视下治疗组,则只有1.2％的病人发生了复发或获得性耐药,他们的治疗成本只占了总治疗成本中的6.0％。结论:直接面视下治疗要比传统治疗经济。
PURPOSE: The treatment of tuberculosis not only takes a long time and is costly, but often complicates treatment because of poor patient compliance. Direct surface treatment (DOT), this out-patient treatment management strategy is to ensure patient compliance. However, this strategy has not been widely implemented because of the high cost of implementing this strategy. The aim of this study was to compare the treatment costs of DOT and traditional treatment in the treatment of tuberculosis. Design: A retrospective economic assessment of 659 reported TB cases from 1980 to 1994 in a county county health bureau. Estimated costs of outpatient care, hospitalization costs, and recurrence and acquired resistance to treatment costs based on 1995 dollar prices. RESULTS: DOT was less costly to treat: $ 15,670 for each hospitalized patient and $ 700 for each outpatient treated patient (P <0.001). The difference in treatment costs is due to different treatment times (334 days vs. 550 days), fewer hospitalizations (58% versus 75%), and shorter hospital stays (26 days vs 55 days per inpatient). The incidence of recurrent or acquired resistance was 10.9% in the traditional treatment group, and the cost of treatment used in these cases was 35.7% of the total treatment cost, whereas in the direct-view treatment group, only 1.2% of patients had recurrent or acquired resistance and their treatment costs accounted for only 6.0% of the total cost of treatment. Conclusion: Direct surface treatment is more economical than conventional treatment.