Pharmaceutical care for pulmonary tuberculosis treatment in Thailand

Abstract

Objectives Three objectives were to compare: 1) treatment success; 2) healthcare resource uses; and 3) out-of-pocket (OOP) expenditures, indirect costs, and health-related quality of life (HRQoL) associated with pharmaceutical care, home visit, and modified DOT in three referral hospitals in Songkhla province, Thailand.

Methods Project 1&2 were retrospective cohort study collecting data from 1,398 pulmonary TB patients who started treatment between October 2010 and September 2013. Project 3 was a prospective study collecting data from 104 pulmonary TB patients who started treatment between January and May 2014. The propensity score matching and generalized linear models (GLMs) were used to compare the outcomes associated with three supervision approaches by adjusting for baseline characteristics.

Results Project1: The differences in treatment success rate were not statistically significant when comparing pharmaceutical care with either home visit (success rate: 92.76% versus 94.74%) or modified DOT (success rate 93.37% for both).

Project2: The mean direct healthcare costs to public payer were $519.96 (95% confidence interval (CI): $437.31 to $625.58) for pharmaceutical care, $1,020.39 (CI:$911.13 to $1,154.11) for home visit, and $887.79 (CI:$824.28 to $955.91) for modified DOT.

Project3: Mean OOP expenditures were $907.56 (CI:$603.80 to $1,269.41), $148.47 (CI:$109.49 to $194.89), and $95.35 (CI:$69.11 to $129.63), while the indirect costs were $1,925.68 (CI:$922.06 to $3,284.94), $2,393.66 (CI:$1,435.01 to $3,501.98), and $833.33 (CI:$453.87 to $1,263.45), for those receiving pharmaceutical care, home visit, and SAT, respectively. Mean health utility scores at the baseline and the end of treatment were 0.679 and 0.830, 0.713 and 0.905, and 0.708 and 0.913 for the patients receiving pharmaceutical care, home visit, and SAT, respectively.

Conclusion Pharmaceutical care is clinically and economically effective compared with the other strategies studied. A large-scale prospective study is warranted to strengthen evidence to support policy making in TB management in Thailand.