An economic evaluation of alternative programme designs for tuberculosis control in rural Uganda

Tuberculosis (TB) and AIDS are infections that are among the most feared of all diseases. Both have been widely discussed by the western media in recent months, for a variety of reasons, but it is the combination of the two diseases in an ever increasing number of patients that is causing concern to health planners and health economists. While AIDS is untreatable and prevention of further infection depends largely on changes in sexual behaviour, TB remains eminently treatable. Preventing the spread of TB depends on the effective treatment of active cases, taking 6–12 months, depending on the drugs used. In order to ensure completion of treatment, a programme of registering and following up patients is required. A number of different programme designs are considered and an analysis of both costs and consequences is attempted in order to find the most cost-effective alternative. Data from western Uganda for 1992 are used for the study and the implications of the findings for both Uganda and other African countries are discussed. It is concluded that a programme based on the ambulatory treatment of patients at their nearest health unit, whilst living at home, is the most cost-effective design, largely because of reduced costs to the patients themselves. Specific recommendations are made regarding the implementation of such a programme.