Table 3.
Direct and indirect costs per tuberculosis patient managed in Zambia
| Type of Cost | Mean | Source |
|---|---|---|
| Pre-Diagnosis | ||
| Number of medical visits | 1.94 | ZCQ† |
| Lab costs (3 AFB smears) | $8.49 | [92] |
| Patient out-of-pocket expenditures for visits | $10.63 | ZCQ† |
| Indirect Lost income for patient/family for visits* | $1.47 | ZCQ† |
| Post-Diagnosis | ||
| Hospitalisation Number of hospital days | 7.13 | ZCQ† |
| Direct Health system costs for hospital days | $98.68 | HCQ‡ |
| Patient out-of-pocket expenditures: hospital days | $128.91 | ZCQ† |
| Indirect Lost income for patient/family for hospital days* | $15.61 | ZCQ† |
| Direct Observation of Treatment (DOT) | ||
| Number of visits | 108 | ZCQ† |
| Direct Health system costs for visits | $78.84 | HCQ‡ |
| Drug costs (new case) | $5.37 | [33] |
| Patient out-of-pocket expenditures for visits | $15.12 | ZCQ† |
| Indirect Lost income for patient/family for visits* | $51.84 | ZCQ† |
| Follow-up | ||
| Number of visits | 7 | ZCQ† |
| Direct Health system costs for visits | $27.44 | HCQ‡ |
| Patient out-of-pocket expenditures for visits | $0.84 | ZCQ† |
| Indirect Lost income for patient/family for visits* | $4.06 | ZCQ† |
| Disability Costs | ||
| Direct Patient miscellaneous direct costs** | $2.12 | ZCQ† |
| Indirect Lost income due to patient disability¶ | $138.10 | ZCQ†, HCQ‡ |
| Family miscellaneous indirect costs¶¶ | $46.44 | HCQ† |
| Total Cost per TB patient managed | ||
| Direct Health system | $226.43 | |
| Patient out-of-pocket and miscellaneous costs | $157.62 | |
| Indirect Patient/family lost income and miscellaneous costs | $257.52 | |
| Total Health system and patient/family | $641.57 | |
| Vaccination | ||
| Initial investment§ - BCG replacement only | $1.20/vaccinated | [7,34,57] |
| With booster (total) | $1.65/vaccinated | [7,34,57] |
| Unit cost§§ - BCG | $2.00 | [93] |
| BCG replacement only | $1.10 †† | [9] |
| With Booster (total) | $3.40 | [9] |
† Values based on Zambian TB Cost Questionnaire 2006 [27]
‡ Values based on Haiti TB Patient Cost Questionnaire [15], where GNI per capita is similar to Zambia
* Lost income based on average per capita gross national income - $500 - [58] and average work week of 40 hours
** Direct patient/family expenditures (while ill with TB disease) that are in addition to money spent while visiting health establishments or hospitals (e.g. cleaning, food supplements, childcare)
¶ Disability costs based on cure/complete treatment outcome (2 months disability) [28-30]
¶¶ Based on total hours spent by family members helping patient at home
§ Initial investment includes research, development, and production costs
§§ Unit cost includes distribution, administration, and vaccine dose costs.
†† BCG replacement unit cost estimates provided by Aeras [9] were lower than that of current BCG - likely secondary to improved manufacturing and/or distribution efficiency