Cost and Cost-Effectiveness of Treating Smear-Positive Tuberculosis by Health Extension Workers in Ethiopia An Ancillary Cost-Effectiveness Analysis of Community Randomized Trial 英文参考文献.docVIP

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Cost and Cost-Effectiveness of Treating Smear-Positive Tuberculosis by Health Extension Workers in Ethiopia An Ancillary Cost-Effectiveness Analysis of Community Randomized Trial 英文参考文献.doc

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CostandCost-EffectivenessofTreatingSmear-Positive TuberculosisbyHealthExtensionWorkersinEthiopia:An AncillaryCost-EffectivenessAnalysisofCommunity RandomizedTrial DanielG.Datiko1,2*,BerntLindtj?rn1 1CentreforInternationalHealth,UniversityofBergen,OverlegeDanielsensHus,Bergen,Norway,2SouthernNations,NationalitiesandPeoples’RegionalStateHealth Bureau,Hawassa,Ethiopia Abstract Background:Evidenceforpolicy-anddecision-makingrelatedtothecostofdeliveringtuberculosis(TB)controlislackingin Ethiopia. We aimed to determine the cost and cost-effectiveness of involving health extension workers (HEWs) in TB treatment under a community-based initiative in Ethiopia. This paper presents an ancillary cost-effectiveness analysis of datafromaRCT,fromwhichthemainoutcomeshavealreadybeenpublished. Methodology/Principal Findings: Options of treating TB patients in the community by HEWs in the health posts and general health workers at health facility were compared in a community-randomized trial. Costs were analysed from a societalperspectivein2007inUSdollarsusingstandardmethods.Weprospectivelyenrolledsmear-positivepatients,and calculatedthecost-effectivenessintermsofthecostperpatientsuccessfullytreated.Thetotalcostforeachsuccessfully treated smear-positive patient was higher in health facilities (US$161.9) compared with the community-based approach (US$60.7). The total, patient and care giver costs of community-based treatment were lower than health facility DOT by 62.6%,63.9%and88.2%,respectively.InvolvingHEWsaddedatotalcostofUS$8.80tothehealthserviceperpatienttreated inthehealthpostsinthecommunity. Conclusions/Significance: Community-based treatment by HEWs costs only 37% of what treatment by general health workerscostsforsimilaroutcomes.InvolvingHEWsinTBtreatmentisacost-effectivetreatmentalternativetothehealth serviceandtothepatientsandtheircaregivers.Therefore,thereisbothaneconomicandpublichealthreasontoconsider involving HEWs in TB treatment in Ethiopia. However, community-based t