Table 4 Using local evidence to estimate the costs (and savings) of options

WHO policy recommends the use of direct observation of treatment (DOT) for treatment delivery for tuberculosis (TB). DOT can be delivered in a number of ways, including through primary healthcare clinics and in the community. An alternative policy option is for patients with TB to self-supervise their own treatment. A study was done in Cape Town, South Africa to assess the costs associated with each of the clinic, community and self-supervised options for treatment delivery. Local data were used to assess the resource input requirements of these three alternative options over a six month period of treatment. These data were then used to estimate the cost per patient treated for each of the three supervision approaches. The results indicated that the cost (in South African Rands) per patient was R3,600 for clinic supervision, R1,080 for self supervision, and R720 for community supervision. The authors concluded that community-based DOT by a volunteer lay health worker may be less costly to the health services than either clinic-based or self supervision [40]. This cost information influenced the city's decision to expand the delivery of DOT using community-based lay health workers.

Policymakers in a Latin American country needed information on the costs of cochlear implants in order to assess the potential costs and savings of interventions to treat hearing loss. A search for local literature using Google identified a report from the Ministry of Health of Chile in which the costs were outlined for the replacement of various components needed for cochlear implants. These data were used to estimate the likely total cost of cochlear implants in the local setting. (The report can be found at: http://www.minsal.cl/ici/rehabilitacion/consentimiento_informado.pdf)