Economic Evaluation On The Supervision And Management Mode Of Implementing First Visit Responsibility For TB Patients In County TB Dispensary Doctors

BackgroundsIn recent years TB prevalence has been re-intensified and became the public health and social problem of global concern once again.World Health Organization(WHO) estimated the current TB patients were 20 million,of which 95%were in developing countries,and new cases from 8 to 10 million occurred every year.China is one of the world's 22 TB high-burden countries and the number of TB patients in the world is the first two.National active TB patients were 4.5 million,of which infectious patients(sputum smear positive) were 1.5 million.There were 1.4 million new cases every year and the number of deaths due to TB was about 130000.TB is the major infectious disease of serious hazard to human health.Active and effective control of TB is far-reaching significant to the promotion of human health.WHO put forward a framework for effective control of TB in 1994 and DOTS management mode spread to the whole world as a global TB control strategy.DOTS management mode,which is directly observed therapy-short course,requires TB patients inject,take medicine and do records under the supervision of medical personnel or trained family members.At the same time the patients are urged to visit doctors regularly in order to observe the drug efficacy and adverse reactions,the progress of the disease and do the necessary inspection until the end of the treatment. POTS management mode has played a positive role on TB control in China, but there are still some problems and shortcomings.Studies have shown that:TB patients exclude taking medicine under others directly observed; the proportion of patients receiving full course supervision in the actual treatment is not high;the interaction between village doctors and patients is constrained by the traditional sense;the knowledge of TB prevention and treatment in patients is low;the potential and role of county TB dispensary doctors are not fully explored. In order to solve the deficiencies of DOTS management mode in the implementation process,a new management mode of TB treatment has been proposed,which is"the supervision and management mode of implementing first visit responsibility for TB patients in county TB dispensary doctors".The mode provides a picture booklet for the TB patients,which calls"the picture booklet of TB patients'treatment knowledge and self-management"and also provides a booklet for the county TB dispensary doctors,which calls"the principle and method of doctors advising TB patients' self-medication management".With the picture booklet as a medium between doctors and patients,the TB patients'capabilities of self-medication management are improved comprehensively through face-to-face guidance and phone counseling of county TB dispensary doctors together with the patient's own learning for picture booklet contents.DOTS management mode requires TB patients take medicine under the supervision of village doctors or family members,but"the supervision and management mode of implementing first visit responsibility for TB patients in county TB dispensary doctors"emphasizes TB patients' regular self-medication under the guidance of county TB dispensary doctors.At present,the mode was only pilot implemented in domestic small areas and the evaluation on the mode was rarely.In order to establish more effective TB management mode,it is necessary to conduct a comprehensive evaluation study on the mode with scientific evaluation theories and methods.This study will use economic evaluation methods to evaluate"the supervision and management mode of implementing first visit responsibility for TB patients in county TB dispensary doctors", which is part of the overall evaluation.ObjectivesTo economic evaluate on"the supervision and management mode of implementing first visit responsibility for TB patients in county TB dispensary doctors"and to provide scientific basis for establish the optimal TB management mode. Contents1.Comparison of the contents and methods between the two different TB management modes2.Cost estimates of the two different TB management modes3.The effectiveness,utility and benefit estimates of the two different TB management modes4.Cost-effectiveness,cost-utility and cost-benefit analysis of the two different TB management modes5.Policy recommendations for the TB management modeMethods1.Literature review2.Expert consultation and key informant interview3.Prospective cohort study4.Survey methods5.Health economics evaluation methods6.Health statistics methodsResultsComparison of the contents and methods between the two different TB management modesDOTS management mode requires TB patients take medicine under the supervision of village doctors or family members,but"the supervision and management mode of implementing first visit responsibility for TB patients in county TB dispensary doctors"emphasizes patients'mastery of TB prevention and treatment knowledge and regular self-medication through learning for picture booklet contents under the guidance of county TB dispensary doctors.In theory,the implementation of"the supervision and management mode of implementing first visit responsibility for TB patients in county TB dispensary doctors"is a change of patients from passive to active treatment,so the treatment compliance of patients is better.Cost-effectiveness analysis1.Cost estimates:to estimate the cost of a TB patient initial treated in the two different TB management modes from the perspective of agency, patient and society.The cost per case in Wanzhou District(study group) was 844.91,1497.06and 1585.10 Yuan separately.The cost per case in Kai County(control group) was 922.34,1728.78 and 1715.45 Yuan separately. The cost per case in Ninghai County(study group) was 745.63,1345.05, and 1352.69 Yuan separately.The cost per case in Xiangshan County (control group) was 886.24,1595.28 and 1674.38 Yuan separately.No matter from which perspective to estimate,the cost in study group is lower than that in control group.2.The awareness of TB prevention and treatment knowledge in study group is higher than that in control group.3.The regular medication rate in study group is higher than that in control group.4.The regular sputum smear rate in study group is higher than that in control group.5.The vast majority of patients in study group take action to contact with county TB dispensary doctors when adverse drug reactions occur,the rate of which is higher than that in control group.6.The cure rate is high both in study and control group,which is more than 95%.The cure rate in study group reaches 100%.7.No matter from agency,patient or society perspective to estimate, the cost of a TB patient initial cured in study group is lower than that in control group.The mode in study group has more cost-effectiveness.Cost-utility analysis1.The DALY loss in study group is lower than that in control group, but overall,the DALY losses of the two different TB management modes are in a lower level.2.The DALY losses retrieved of the two different TB management modes are about 10 years,which in study group is slightly higher than that in control group.3.No matter from agency,patient or society perspective to estimate, the cost per DALY loss retrieved in study group is lower than that in control group.The mode in study group has more cost- utility.Cost-benefit analysis1.The benefit of a TB patient initial treated is more than 25000 Yuan in Wanzhou District,more than 22000 Yuan in Kai County,more than 71000 Yuan in Ninghai County and more than 59000 Yuan in Xiangshan County.The benefit in study group is higher than that in control group.2.No matter from agency,patient or society perspective to estimate, the benefit received from 1 Yuan cost in study group is higher than that in control group.The benefit is several times of the cost.The mode in study group has more cost-benefit.Suggestions1.The implementation of"the supervision and management mode of implementing first visit responsibility for TB patients in county TB dispensary doctors"has necessity,feasibility and significance.2.Increase government subsidy to TB patients in the poor,floating and remote areas population,so as to improve the health of the patients.3.Strengthen the training of county TB dispensary doctors on TB comprehensive prevention and treatment knowledge,enhance their communication skills of health education and mobilize their internal work enthusiasm.4."The supervision and management mode of implementing first visit responsibility for TB patients in county TB dispensary doctors"is a cost-effective TB management mode,which is worthy of further promotion.