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Costing Provision of Tuberculosis Care in Nigeria

Health Systems 20/20 has developed a customizable costing model in MS-Excel to look at the direct cost implications of the Nigerian tuberculosis (TB) control program over 2008-12. Full-time equivalent health workers required for clinical TB care are also estimated.

With a baseline scenario for an increase in the TB-DOTS caseload, this model projected Nigeria’s total direct costs of the directly observed treatment, short-course (DOTS), multi-drug resistant tuberculosis (MDR-TB), and TB-HIV program to be US$17 million in 2012. Additional scenarios were costed, which varied the rate of DOTS case registrations and treatment outcomes, etc.

The Nigerian TB treatment program looks sustainable if current TB case complication and drug resistance rates remain stable. Additional costs of MDR-TB treatment could become significant. Hence attention should be paid to MDR-TB prevention. Nigeria needs to further improve DOTS treatment outcomes. Strengthening DOTS by an increase in labor input per active TB case by clinical workers is one option for deepening treatment quality, which was costed with the tool. The option was found to be affordable and would also save additional lives.