A Cost Effect Analysis of Utilising Community Health Workers in the Management of Tuberculosis, Kenya

Abstract

Introduction: Community Health Workers (CHWs) have been utilised for various primary health care activities in different settings especially in developing countries. Usually when utilised in well defined terms, they have a positive impact. Objectives: The overall objective of this study was to undertake a cost effect analysis of utilising CHWs in tuberculosis (TB) management. Methods: A retrospective cohort study was conducted in selected health facilities using standard clinical records for each TB patient registered for treatment between 2005 to 2011. Results: The study assessed 2778 tuberculosis patients and among them 1499 (54%) utilized CHWs for their TB treatment. The cost effect analysis revealed that the average cost per Disability Adjusted Life Year (DALY) averted for treatment success was higher (184 US$) in the cohort that utilised CHWs compared to the nonutilising cohort (87 US$). Use of CHWs resulted in better treatment success rate (82.15%) compared to not using at 72.25% (p-value <0.001). Utilising CHWs resulted in less DALYs (5688) from death compared to not utilising CHWs (5725). Of the patients who died, a majority ( ) died within the first month of their treatment and they were in the cohort that did not utilise CHWs. Conclusion: The use of CHWs may be considered as a health and economic benefit because more life was saved with a higher treatment success rate and there seemed to be death averted in the early months of TB treatment.