April 2007

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Nurse case managers provide an important supportive function in the provision of directly observed therapy to tuberculosis patients. Case management costs have not previously been reported in the literature. This study aimed to establish an estimate of the cost per patient for nurse case management in Oregon. The state health department currently provides monetary support to counties for case management, to encourage uniformity in tuberculosis control. We evaluated the adequacy of these funds. Nurse case managers were selected from Multnomah and Marion County health departments to collect data on the amount of time each TB patient required per week. These data were merged with patient information from public health records. Mixed effects modeling techniques were used to identify patient factors associated with case management time. Mean and predicted costs were calculated. The factors associated with increased case management time were non-compliance with directly observed therapy, the use of incentives, and the presence of one of several important treatment factors (e.g. an adverse reaction). The mean case management cost was $4831. Cost predictions for a standard treatment ranged from $2932 for the simplest case to $6530 for a complex one. After including outreach worker time, the average personnel cost increased to $5979 with predictions ranging from $4052 to $7721. These estimates are substantially higher than the current available state funding for case management. Using these data, more informed budget decisions can be made to allot appropriate amounts of money to the county health departments for TB control.




School of Medicine



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