Abstract
Objectives
We have estimated tuberculosis (TB)-related expenditures by governments and other third parties in Canada in 2004, in order to compare spending on different activities, by various jurisdictions, and in different regions.
Methods
To ascertain health system costs (including public health costs), a self-administered questionnaire was completed by all federal, provincial, and territorial health departments and laboratories involved in TB activities and a sample of local health departments. Hospitalization information was obtained from the Canadian Institute for Health Information, while costs for care were derived from published literature. Costs borne by patients and families were not included. All costs were ascertained for 2004 and expressed in Canadian dollars.
Results
In 2004, total TB-related expenditures in Canada were $74 million, equivalent to $47,290 for every active TB case diagnosed in that year. Research accounted for $4.5 million (or 6% of the total). Non-research-related federal spending accounted for $16.3 million (22%) and provincial/territorial expenditures accounted for $53.1 million (72%). Active tuberculosis accounted for $31 million or 59% of provincial/territorial expenditures. There were substantial regional differences in TB-related expenditures; the highest expenditures were in the Northern Territories ($72,441 per active TB case), followed by the four Western provinces ($35,914), and lowest in the Atlantic provinces ($28,259).
Conclusions
Total TB-related expenditures in Canada in 2004 were considerable, of which almost 60% were for curative services and only 40% for prevention and control activities. Regional differences likely reflect differences in accessibility of the populations to health care services, and greater interventions in communities with ongoing TB transmission.
Key words: TB control; costs for control; public health costs; TB costs
Résumé
Objectifs
Nous avons estimé les sommes consacrées à la lutte antituberculeuse par les gouvernements et d’autres organismes au Canada en 2004 afin de comparer les dépenses par activité, par province ou territoire et par région.
Méthode
Pour vérifier les coûts du système de santé (y compris les coûts de santé publique), nous avons envoyé un questionnaire à tous les services de santé et laboratoires fédéraux, provinciaux et territoriaux intervenant dans les activités antituberculeuses et à un échantillon de services de santé locaux. L’Institut canadien d’information sur la santé nous a communiqué les données sur les hospitalisations, et nous avons estimé les coûts des soins d’après les études publiées sur le sujet. Les coûts défrayés par les patients et les familles n’ont pas été comptabilisés. Tous les coûts visent l’année 2004 et sont exprimés en dollars canadiens.
Résultats
En 2004, les dépenses liées à la tuberculose au Canada se sont chiffrées à 74 millions de dollars (M$), soit 47 290 $ par cas de tuberculose active diagnostiqué pendant l’année. La recherche a coûté 4,5 M$ (6 % du total). Les dépenses fédérales non liées à la recherche ont représenté 16,3 M$ (22 %), et les dépenses provinciales et territoriales, 53,1 M$ (72 %). La tuberculose active a coûté 31 M$, soit 59 % des dépenses provinciales et territoriales. On note d’importants écarts régionaux dans les dépenses liées à la tuberculose; les plus élevées ont été enregistrées dans les territoires nordiques (72 441 $ par cas de tuberculose active) et dans les quatre provinces de l’Ouest (35 914 $), et les dépenses les plus faibles, dans les provinces de l’Atlantique (28 259 $).
Conclusion
Les dépenses totales liées à la tuberculose au Canada en 2004 ont été considérables; près de 60 % ont été consacrées aux services de soins, et 40 % seulement aux activités de prévention et de contrôle. Les écarts régionaux reflètent probablement les différences dans l’accès des populations aux services de santé et les interventions plus poussées dans les localités où la tuberculose est endémique.
Mots clés: lutte antituberculeuse, coûts des interventions, coûts de santé publique, coûts de la tuberculose
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