Costs for tuberculosis care in Canada.

OBJECTIVES We have estimated tuberculosis (TB)-related expenditures by governments and other third parties in Canada in 2004, in order to compare spending on different activities, by various jurisdictions, and in different regions. METHODS To ascertain health system costs (including public health costs), a self-administered questionnaire was completed by all federal, provincial, and territorial health departments and laboratories involved in TB activities and a sample of local health departments. Hospitalization information was obtained from the Canadian Institute for Health Information, while costs for care were derived from published literature. Costs borne by patients and families were not included. All costs were ascertained for 2004 and expressed in Canadian dollars. RESULTS In 2004, total TB-related expenditures in Canada were $74 million, equivalent to $47,290 for every active TB case diagnosed in that year. Research accounted for $4.5 million (or 6% of the total). Non-research-related federal spending accounted for $16.3 million (22%) and provincial/territorial expenditures accounted for $53.1 million (72%). Active tuberculosis accounted for $31 million or 59% of provincial/territorial expenditures. There were substantial regional differences in TB-related expenditures; the highest expenditures were in the Northern Territories ($72,441 per active TB case), followed by the four Western provinces ($35,914), and lowest in the Atlantic provinces ($28,259). CONCLUSIONS Total TB-related expenditures in Canada in 2004 were considerable, of which almost 60% were for curative services and only 40% for prevention and control activities. Regional differences likely reflect differences in accessibility of the populations to health care services, and greater interventions in communities with ongoing TB transmission.