Tuberculose em Salvador: custos para o sistema de saúde e para as famílias

João G Costa,Laura C Rodrigues,Andreia C Santos,Mauricio L Barreto,Jennifer A Roberts

doi:10.1590/s0034-89102005000100016

Abstract

Tuberculosis is one the greatest causes of mortality worldwide, but its economic effects are not well known. This study had the objective of estimating the costs to the public and private healthcare systems and to families of tuberculosis treatment and prevention. This study was made in the municipality of Salvador, State of Bahia, Brazil, in 1999. Data for estimating the costs to the healthcare system were collected from the Department of Health, healthcare facilities and a philanthropic institution. The public and private costs were analyzed using cost accounting methodology. Cost data relating to families were collected by means of questionnaires, and included data on transportation, food and other expenses, and also income losses associated with this disease. The average cost of treating one new case of tuberculosis was approximately US$103. The cost of treating one multiresistant patient was 27 higher than this. The cost to the public services consisted of 65% on hospitalization, 32% on treatment, and only 3% on prevention. The families committed around 33% of their income on expenses related to tuberculosis. Despite the fact that the families did not have to pay for medications and treatment, given that this service is offered by the State, the costs to families related to loss of income due to the disease were very high. The proportion of public service funds utilized for prevention is small. Greater investment in prevention campaigns not only might diminish the numbers of cases but also might lead to earlier diagnosis, thus reducing the costs associated with hospitalization. The lack of an integrated cost accounting system makes it impossible to visualize costs across the various sectors.

Highlights

The report of the Commission on Macroeconomics and Health of the World Health Organization[7] has emphasized that tuberculosis is the most common of the infectious diseases
To study the cost of tuberculosis for patients and their families, the sample size was defined by convenience, to include 146 patients who had received a diagnosis of tuberculosis for the first time, 33 hospitalized patients and 39 patients with multiresistant tuberculosis
For the family of a patient who was diagnosed with tuberculosis for the first time and was treated as a new outpatient the cost was US$266

Summary

Introduction

The report of the Commission on Macroeconomics and Health of the World Health Organization[7] has emphasized that tuberculosis is the most common of the infectious diseases. Onethird of the world’s population is infected with Mycobacterium tuberculosis and around 5% to 10% of infected individuals will become ill and infective at some time during their lives. The same report has estimated that, if not controlled, tuberculosis will be responsible for the death of 35 million people over the 20 years. Brazil ranks tenth in the world in numbers of cases, with around 83,000 cases notified every year, in all age groups but especially among those aged over twenty years old. In the State of Bahia, around 7,800 cases occur every year, which corresponded to an incidence of 60.3/100,000 in-.

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Discussion

Conclusion