What is the Cost of Diagnosis and Management of Drug Resistant Tuberculosis in South AfricaReport as inadecuate




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Background

Drug-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.

Methodology

We 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 Findings

Assuming 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-Significance

Although 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.



Author: Anil Pooran, Elize Pieterson, Malika Davids, Grant Theron, Keertan Dheda

Source: http://plos.srce.hr/



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