WHO report 2008
Global tuberculosis control
3.5 Budgets and costs per patient
Budgets and costs per patient in HBCs are shown in Table 3.5. The budget for first-line anti-TB drugs per patient is lowest in India (US$ 14) and Zimbabwe (US$ 12), and highest in Brazil (US$ 77), Mozambique (US$ 63) and the Russian Federation (US$ 286). In most countries, the budget is in the range US$ 20–40.
The budget per patient, including all line items, also varies. Three countries have budgets below US$ 100 per patient (Ethiopia, India and Zimbabwe). A total of six countries have budgets in the range US$ 100–200 per patient, five are in the range US$ 200–300 and three are in the range US$ 300–550.1 The Russian Federation and South Africa are the only two countries with a budget exceeding US$ 1000 per patient (for reasons discussed in section 3.3.1), but budgets are also relatively high in Brazil and the United Republic of Tanzania. Brazil is a middle-income country, and comparatively high costs are expected; the high cost in the United Republic of Tanzania reflects the inclusion, for the first time, of the budget for the full range of collaborative TB/HIV activities, even when some of those activities are funded and provided by the national AIDS control programme (see also sections 3.2.1 and 3.3.2).
In 2008, the total cost per patient treated is estimated at under US$ 100 in only one country: India. It is in the range US$ 100–300 in 12 countries (as in 2007), and US$ 300–500 in three countries (also as in 2007). Five countries have much higher costs: Brazil, Mozambique, the Russian Federation, South Africa and the United Republic of Tanzania. As noted above, three of these countries are middle-income countries with generally higher prices for the inputs needed for TB control, while the Russian Federation and South Africa have large budgets for MDR-TB treatment as well as maintenance or upgrading of hospital infrastructure. Costs of US$ 774 in the United Republic of Tanzania and US$ 685 in Mozambique are due mainly to comprehensive budgeting for collaborative TB/HIV activities (see also sections 3.2.1 and 3.3.2 and Annex 1).
Among the low-income countries, there is no clear-cut relationship between the cost per patient treated and GNI per capita. For example, in India and Pakistan the cost per patient treated is low relative to income levels, while in the Democratic Republic of the Congo and Mozambique the cost per patient treated is relatively high compared with GNI per capita (data not shown). Overall, budgets and costs per patient are generally increasing, with a median increase of 200% per patient for budgets and of 210% for total costs (though the median for first-line drugs shows a decrease of 20% since 2002).
1 Figures were not calculated for Thailand because the budget and health services utilization data reported to WHO were incomplete.