October 1, 1996
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"Health policies that seek only to save money in the short term ultimately may be both inferior to and more expensive than a more comprehensive approach..."
Researchers at Johns Hopkins have shown for the first time that spending more time and money up front to keep tuberculosis patients on strict drug regimens saves money in the long run.
The cost-effective strategy, called directly observed therapy (DOT), cures more people sooner and decreases the risk of developing TB germs resistant to treatment, says Richard E. Chaisson, M.D., associate professor of medicine.
The researchers found that using DOT throughout the United States would save $25 million compared with conventional therapy, save 240 additional lives, and prevent 2,400 relaspes, including 100 with drug-resistant TB.
"Many doctors and health departments have felt that DOT is too expensive because of the cost of hiring nurses to monitor each patient's treatment. We have shown that not using DOT is even more expensive because people taking medicine without supervision are more likely to fail therapy," says Chaisson.
The findings also support a 1978 Baltimore city decision to set up a DOT program in which health care workers regularly visit patients at home or work to ensure compliance with drug treatment.
From 1981 through 1992, while TB rates increased 1.8 percent among the 20 cities with the highest TB rates in 1981, the rate declined by 51.7 percent in Baltimore, according to a previous report by Hopkins researchers. After instituting DOT, Baltimore's TB rate fell from the second highest in the nation to 32nd by 1994.
Results of the current study appear in the October 1996 issue of the American Journal of Respiratory and Critical Care Medicine.
The Hopkins team compared standard costs and fees for laboratory and hospital care and health care worker salaries for DOT with two other strategies, conventional individual drug therapy and fixed-dose combination individual drug therapy. In conventional individual drug therapy, patients take several different anti-TB pills individually, a practice that many TB patients find inconvenient. Fixed-dosed combination individual drug therapy is more convenient because patients take multiple drugs at the same time in a single capsule. This treatment was more effective and less expensive than conventional individual drug therapy, which was the least effective and most expensive form of therapy, according to the study.
Overall, the average cost per patient treated was $13,925 for DOT, $13,959 for fixed-dose combination therapy, and $15,003 for conventional therapy.
"Our findings show that health policies that seek only to save money in the short term ultimately may be both inferior to and more expensive than a more comprehensive approach like DOT," says Chaisson.
Other authors of the study include Richard D. Moore, C. Patrick Chaulk, Robert Griffiths and Solange Cavalcante.
The study was supported in part by Marion Merrell Dow Inc.