Economic Analysis of the Health Care Intervention: A Case Study of the Hospitalization and Ambulatory Treatment of MDR-TB in Pakistan

Abstract

This study analyses the cost-effectiveness of treatment arms of multi-drug resistance tuberculosis (MDR-TB) namely hospital and ambulatory care in Pakistan. Alongside that a number of factors that correlate with the outcome of cure and loss to follow-up of MDR-TB patients in Pakistan are analyzed. We have collected the data of 438 MDR-TB patients registered for the treatment of MDR-TB by the National Tuberculosis Program (NTP) of Pakistan from 2012 to 2017 from three regions of Pakistan namely TB Samli Sanatorium Hospital, Muree, Gulab Devi Hospital, Lahore, and Ojha Institute of Chest Disease, Karachi. The results indicate that no treatment care shows a continuous dominance in the cost effectiveness analysis and both arms have played an important role in the reduction of disease burden for the patients. Hence, both treatment cares can be accepted simultaneously as appropriate strategies for the treatment of MDR-TB in Pakistan. The outcome of cure is not related to the treatment care and is positively related to the medical and time expenditure. The loss to follow-up has an insignificant relation with the treatment care, significantly increases with the catastrophic health care expenditure and reduces with the financial incentives Moreover when the patients facing catastrophic expenditure are given financial incentives then the loss to follow-up reduces significantly. Our study supports the use ambulatory care for the treatment of MDR-TB in Pakistan alongside a hospital arm. The financial impediments need to be reduced for the patients and financial incentives may be continued and ensured by the health programs to support the patients. Keywords: Multi-drug resistance tuberculosis, cost-effectiveness, Hospital care, Ambulatory care, Catastrophic health care expenditure, Financial incentives