Sharing a article in Feb 2016 issue of Tropical Medicine and International Health

Cost-optimization in the treatment of multi-drug resistant tuberculosis in Nigeria



To compare the cost of facility-based MDR TB care (F) to home-based care (H) from the perspective of the Nigerian national health system.


We assessed the expected costs of the two MDR TB treatment approaches using a decision-analytic model with a follow-up of 6 months. MDR TB treatment outcomes were obtained from a systematic review of randomized clinical trials. The outcomes of interest included treatment success, treatment failure, treatment default, and mortality, and did not vary significantly between the two alternatives. Treatment costs included the cost of: drug therapy (F, H), hospital stay (F), nurse care (F, H), physician care (F), nursing facility (F), and transport to the health care provider (H). Finally, we estimated the potential cost savings associated with home-based treatment for all patients starting MDR TB treatment in Nigeria.


The average expected total treatment cost for a Nigerian patient treated for MDR TB was estimated at US$ 2095 for facility-based care and $ 1535 for home-based care, a potential saving of 25%. One of the major drivers of this difference is the significantly more intensive, and therefore more costly, nursing care in hospitals. In 2013, a total of 426 patients were initiated on facility-based MDR TB treatment in Nigeria. Thus the potential savings through home-based care are US$ 223,204 per year.


In Nigeria, treatment of MDR TB using home-based care is expected to result in similar patient outcomes at markedly reduced public health costs as facility-based care.


Denny John