Cost and cost-effectiveness of increased community and primary care facility involvement in XXXX care in Machakos District, Kenya.

@entity1 @entity378
SETTING: Machakos District, Kenya, a rural area 50 km east of Nairobi. OBJECTIVE: To assess the cost and cost-effectiveness of new treatment strategies for @entity378 @entity1 , involving decentralisation of care from hospitals to peripheral health units and the community, compared to the conventional approaches to care used until October 1997. METHODS: Costs were analysed in 1998 US dollars from the perspective of health services, @entity1 , family members and the community, using standard methods. Separate analyses were undertaken for 1) new smear-positive pulmonary @entity1 and 2) new smear-negative and extrapulmonary @entity1 . Cost-effectiveness was calculated as the cost per @entity1 successfully completing treatment (smear-positive cases) and as the cost per @entity1 completing treatment (new smear-negative and extra-pulmonary cases). FINDINGS: The cost per @entity1 treated for new smear-positive @entity1 was dollars 591 with the conventional hospital-based approach to care, and dollars 209 with decentralised care. Costs fell from all perspectives, and by 65% overall. Cost-effectiveness improved by 66%. The cost per @entity1 treated for new smear-negative/extra-pulmonary @entity1 was dollars 311 with the conventional approach to care, and dollars 197 with decentralised care. Costs fell from all perspectives, and cost-effectiveness improved by 61%. CONCLUSION: There is a strong economic case for expansion of decentralisation and strengthened community-based care in Kenya. The National @entity378 and Leprosy Control Programme will require new funds for start-up training and community mobilisation costs in order to do this.
