Non-hospital DOT and early diagnosis of tuberculosis reduce costs while achieving treatment success.

OBJECTIVE 1) To evaluate the tuberculosis (TB) related financial burden of patients and health care providers over the course of diagnosis and treatment by choice of directly observed treatment (DOT); and 2) to examine treatment outcomes for different DOT programmes in Cambodia. SETTING AND DESIGN: Subjects were patients diagnosed with smear-positive pulmonary TB between July 2008 and January 2009 at 17 health facilities providing multiple DOT programmes. Treatment outcomes for the different DOT programmes as well as direct and indirect household costs and medical delivery costs for the treatment and care of 277 patients were examined. RESULTS Per patient costs of anti-tuberculosis treatment for patients with non-multidrug-resistant TB who did not have human immunodeficiency virus co-infection ranged from a high of US$1900 for in-patient DOT to a low of $395 for DOT provided at home. All costs among patients treated with hospital DOT were consistently higher than for those treated with non-hospital DOT. The percentage of treatment success was not significantly different between hospital and non-hospital DOT programmes (all >89%). CONCLUSION Non-hospital DOT programmes ease the financial burden on both patients and health care providers, while resulting in treatment success rates similar to those of hospital DOT.