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Table 3 Direct and indirect costs per tuberculosis patient managed in Zambia

From: Cost-effectiveness of novel vaccines for tuberculosis control: a decision analysis study

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]

  1. † Values based on Zambian TB Cost Questionnaire 2006 [27]
  2. ‡ Values based on Haiti TB Patient Cost Questionnaire [15], where GNI per capita is similar to Zambia
  3. * Lost income based on average per capita gross national income - $500 - [58] and average work week of 40 hours
  4. ** 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)
  5. ¶ Disability costs based on cure/complete treatment outcome (2 months disability) [28–30]
  6. ¶¶ Based on total hours spent by family members helping patient at home
  7. § Initial investment includes research, development, and production costs
  8. §§ Unit cost includes distribution, administration, and vaccine dose costs.
  9. †† 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
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BMC Public Health

ISSN: 1471-2458

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