An effectiveness and cost analysis of presumptive treatment for Mycobacterium tuberculosis

Abstract

Delay in treatment of tuberculosis has contributed to both the spread of tuberculosis and its case fatality rate. Decision analysis was used to examine the effectiveness and cost of presumptive treatment in patients evaluated for tuberculosis. Over a range of assumptions, empiric antituberculous therapy for acid-fast bacillus smear-positive persons lowers mortality and cost per person evaluated when available rapid diagnostic laboratory methods for tuberculosis are used. In contrast, the average cost per life saved by giving presumptive treatment to all acid-fast bacillus smear- and HIV-negative patients exceeds. $1 million. Empiric treatment for HIV-infected patients with acid-fast bacillus-negative smears decreases average mortality by 2% at an additional cost of $8000 per life saved. When the prevalence of multiple-drug resistance exceeds 9.6%, presumptive drug-resistant therapy for acid-fast bacillus smear-positive patients, rather than the initial four-drug regimen recommended for much of the United States, minimizes both mortality and costs. Empiric antituberculous therapy often minimizes average mortality and cost for patients evaluated for tuberculosis when rapid diagnostic methods are used.