Tuberculosis: cost of illness in Germany.

4,444 new cases of tuberculosis (TB) were reported in Germany in 2009; of those, the proportion of multidrug-resistant (MDR)-TB cases increased to 2.1% (63 cases). On the basis of the therapy guidelines of the German Central Committee against Tuberculosis and the new World Health Organization guidelines, this study estimates the mean direct outpatient and combined in- and outpatient costs of TB, together with other attributable costs of the disease on the basis of the most recent German official health statistics and scientific literature. According to this, the mean outpatient costs (rounded) per case were €1,197 (adults) and €1,006 (children) for standard therapy, but €36,543 for treatment of MDR-TB. The mean combined in-patient/outpatient costs were €7,364 (adults) and €7,300 (children), respectively; the combined costs for treatment of MDR-TB amounted to €52,259. Including MDR-TB cases the mean costs of treatment per TB case were €7,931. These are joined by the mean costs due to loss of productivity (€2,313), costs per case for rehabilitation (€74) and contact tracing (€922), adding up to €11,240. When considering the probability of increasing numbers of MDR-TB cases in the near future, TB is still a disease of significant economic impact in Germany.