Abstract
BackgroundDrug-resistant tuberculosis (DR-TB) is undermining TB control in South Africa. However, there are hardly any data about the cost of treating DR-TB in high burden settings despite such information being quintessential for the rational planning and allocation of resources by policy-makers, and to inform future cost-effectiveness analyses.MethodologyWe analysed the comparative 2011 United States dollar ($) cost of diagnosis and treatment of drug sensitive TB (DS-TB), MDR-TB and XDR-TB, based on National South African TB guidelines, from the perspective of the National TB Program using published clinical outcome data.Principal FindingsAssuming adherence to national DR-TB management guidelines, the per patient cost of XDR-TB was $26,392, four times greater than MDR-TB ($6772), and 103 times greater than drug-sensitive TB ($257). Despite DR-TB comprising only 2.2% of the case burden, it consumed ∼32% of the total estimated 2011 national TB budget of US $218 million. 45% and 25% of the DR-TB costs were attributed to anti-TB drugs and hospitalization, respectively. XDR-TB consumed 28% of the total DR-TB diagnosis and treatment costs. Laboratory testing and anti-TB drugs comprised the majority (71%) of MDR-TB costs while hospitalization and anti-TB drug costs comprised the majority (92%) of XDR-TB costs. A decentralized XDR-TB treatment programme could potentially reduce costs by $6930 (26%) per case and reduce the total amount spent on DR-TB by ∼7%.Conclusion/SignificanceAlthough DR-TB forms a very small proportion of the total case burden it consumes a disproportionate and substantial amount of South Africa’s total annual TB budget. These data inform rational resource allocation and selection of management strategies for DR-TB in high burden settings.
Highlights
Tuberculosis (TB) remains a major public health crisis in subSaharan Africa despite declining global TB incidence rates [1]
We only modelled new cases of Multidrug-resistant TB (MDR-TB) and XDR-TB and did not include retreatment cases. {Assumed that all drug sensitive TB (DS-TB) patients are treated at a primary care clinic and none are hospitalized. {This estimate was provided by Brooklyn Chest Hospital. 1A figure of 50% is assumed for the decentralized XDR-TB model based on a proportion of patients from an XDR-TB cohort who weigh .50 kg, "Not incorporated into our model as we assume all DS-TB patients complete a full course of treatment, whether they are cured or they fail treatment. #Assumed to be the same as XDR-TB
While XDR-TB drugs do make up a significant proportion of these costs (36%), hospitalization contributes to 56% of the total XDR-TB costs (Figure 1)
Summary
Tuberculosis (TB) remains a major public health crisis in subSaharan Africa despite declining global TB incidence rates [1]. Achieving the United Nations Millennium Development goal to reduce the burden of TB by 50% in 2015 seems unlikely in this region [2]. This is due to several reasons including unsuccessful treatment programmes, the HIV epidemic, increasing economic deprivation and the emergence of drug resistant TB (DR-TB) [3,4]. The situation, fuelled by high transmission rates and HIV co-infection, is dire in South Africa which has the one of the highest TB incidence rates and the 5th highest DR-TB burden globally [1,5]. There are hardly any data about the cost of treating DR-TB in high burden settings despite such information being quintessential for the rational planning and allocation of resources by policy-makers, and to inform future cost-effectiveness analyses
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