Shifting the balance between in-patient and out-patient care for tuberculosis results in economic savings

SETTING: Although hospitalisation is not always necessary for the treatment of tuberculosis (TB), in Australia 90% of TB patients have treatment initiated in hospital.OBJECTIVE: To calculate and compare the costs of inpatient and out-patient tuberculosis treatment, and to measure the impact of shifting care from in-patient to outpatient settings.METHODS: In a costing study performed in Victoria, Australia, the proportion of all notified TB cases who were hospitalised was calculated by matching coded state hospital morbidity data with the Victoria Notifiable Diseases database for the financial year 1994-1995. In-patient and out-patient costs were calculated using data obtained from a number of sources. The effect on health care costs of varying the proportion of TB cases treated as in-patients and out-patients was calculated using Excel.RESULTS: Nearly 90% (239/269) of notified TB cases received hospitalised care in 1994-1995, The cost of treatment for hospitalised patients (mean length of stay 2 weeks) was AU$5447 per patient, with a total cost of $1301833. Hospitalisation comprised 60% of the total cost of treatment. The cost of out-patient treatment was $2260 per patient. If 90% of patients were treated on an out-patient basis, the total cost would be $693670. We estimated that it would be feasible to treat at least 55% of TB patients as out-patients, reducing costs by nearly 30%.CONCLUSIONS: Routine hospitalisation for patients with uncomplicated TB is not necessary, but is often used in industrialised countries. More cost-effective use of resources can be achieved by giving initial TB treatment on an out-patient basis rather than in hospital for a greater proportion of cases.