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RCT
on the Cost-effectiveness of an Innovative Patient Motivation Strategy
in the Management of Pulmonary Tuberculosis
Ghosh CS, Ravindran P, Sumangala S, Joshi M
Abstract:
Objective:
To evaluate the cost-effectiveness of an innovative patient motivation
strategy in improving compliance to chemotherapy in pulmonary
tuberculosis.
Design
: Randomized Control Trial
Setting:
Tertiary Care setting
Participants:
530 newly diagnosed sputum smear and X-ray positive pulmonary
tuberculosis cases attending the Chest Clinic of Medical College,
Trivandrum.
Intervention:
Study patients were randomized to intervention (267) and control (263)
groups. Intervention patients received innovative motivation strategy
in addition to chemotherapy. Motivation included strategies to improve
disease awareness, need for regular therapy, and consequences of
default, reinforcement , token payment, and contracting. Control
patients received routine therapy for 6 months.
Main
outcome measures: Proportion of patients who completed more than 85%
of prescribed medication and death. Cost estimates included out of
pocket expenditure, cost of diagnosis and treatment of tuberculosis,
cost of intervention and total expenditure for management. Cost
imputed from market price. Direct cost used for calculation.
View point: Patient
and Societal
Results:
Follow up data was available for 504 cases. 253 controls ( C) and 251
Intervention (I) group. Male female ratio was 8:2. Base line
characteristics were similar in both groups. Treatment completion rate
was 70% (177) for (C) and 88% (221) for (1) group (p = 0.001).
Mortality was 7% (18) for ( C) and 2%
( 7) for ( I) group (p = 0.023). Average out of pocket per
patient expenditure was Rs.837 + 537 for ( C) and Rs.786 +
583 for (I) group (p = 0.119). Average per patient treatment cost was
Rs.2637 + 537 for ( C) and Rs.2736 + 583 for ( I) group
(p = 0.635). Intervention patients incurred incremental cost of
Rs.2.00. 3.18 million TB patients in India incur Rs.3180 million for
palliation which is 50% of actual treatment cost.
Conclusion: Intervention
patients showed better completion rate and mortality rate compared to
controls without significant rise in cost. Resource for curative
treatment can be significantly improved if palliative expenditure can
be minimized by early detection.
To
Evaluate the Effect of Sputum Induction on Spirometric Parameters in
Asthmatics, Chronic Smokers and Normal Adults
Gupta KB,Manav Manchanda, Sanjeev Tandon,Dept.of Chest &
Tuberculosis,Pt.BD Sharma Postgraduate Institute of Medical
sciences,Rohtak, Haryana.
Abstract:
Background:
Sputum induction has been proposed as a technique to collect
secretions and inflammatory cells from the airways of subjects with
bronchial asthma or with history of smoking.
Methods: In the present study
we evaluated the effect of sputum induction on spirometric parameter
in asthmatics, smokers and healthy adults. A total of 60 asthmatics,
20 smokers and 20 healthy adults were subjected to sputum induction.
The asthmatics were pretreated with 200mg
of salbutamol before the procedure.
Results: The
spirometric parameters also had a higher fall
in asthmatics when compared from smokers and normal adults. The
fall of FEV1 was 14%, 9% and 2% respectively in these groups. The fall
in PEFR was 16%, 5% and 1% and fall in FVC was 11.6%, 6% and 2%
respectively in asthmatics, smokers and normal adults.
Conclusion:
Thus present study concluded that sputum induction has significant
effect on spirometric values specially in asthmatic patients and may
cause worsening of symptoms and these patients require close
monitoring during the procedure.
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