Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Trop Med Int Health. 2013 Jan;18(1):109-16. doi: 10.1111/tmi.12018. Epub 2012 Nov 21.
In South Africa, patients with multi-drug-resistant tuberculosis (MDR-TB) are hospitalised from MDR-TB treatment initiation until culture conversion. Although MDR-TB accounts for <3% of incident TB in South Africa, 55% of the public sector TB budget is spent on MDR-TB. To inform new strategies for MDR-TB management, we estimated the per-patient cost (USD 2011) of inpatient MDR-TB treatment.
All resources used by patients admitted to the MDR-TB hospital with confirmed MDR-TB from March 2009 to February 2010 were abstracted from patient records for up to 12 months after initial admission or until the earliest of final discharge, abscondment or death. Costs of hospital stay/day were estimated from hospital expenditure records and costs for drugs, laboratory tests, radiography and surgery from public sector sources. 133 patients met study inclusion criteria of whom 121 had complete cost records.
By 12 months, 86% were discharged with culture conversion, 8% died in hospital, 2% were still admitted, and 3% had absconded. The mean hospital stay was 105 days. The mean total cost per patient was $17 164, of which 95% were hospitalisation costs (buildings, staff, etc.) and ≤ 2% each for MDR-TB drugs ($380); TB laboratory tests, including drug susceptibility testing ($236); and other costs.
The inpatient cost per patient treated for MDR-TB is more than 40 times the cost of treating drug-susceptible TB in South Africa. There is potential for substantial cost savings from improved management of drug-susceptible TB and shifting to a model of decentralised, outpatient MDR-treatment.
在南非，耐多药结核病（MDR-TB）患者从开始 MDR-TB 治疗到培养转阴都需要住院治疗。尽管 MDR-TB 在南非占新发结核病的比例不到 3%，但公共部门结核病预算的 55%用于 MDR-TB。为了为 MDR-TB 管理提供新的策略依据，我们估算了耐多药结核病住院治疗的每位患者费用（2011 年美元）。
从 2009 年 3 月至 2010 年 2 月，从患者记录中提取了所有在确诊 MDR-TB 后被收住耐多药结核病医院的患者的资源使用情况，最长可达初次入院后 12 个月，或直至最早的出院、潜逃或死亡。从医院支出记录中估算了住院日费用，从公共部门来源估算了药物、实验室检查、影像学和手术的费用。符合研究纳入标准的 133 名患者中，有 121 名患者有完整的成本记录。
在 12 个月时，86%的患者培养转阴出院，8%的患者在医院死亡，2%的患者仍在住院，3%的患者潜逃。平均住院时间为 105 天。每位患者的平均总费用为 17164 美元，其中 95%为住院费用（建筑物、员工等），MDR-TB 药物费用占比≤2%（380 美元）；结核病实验室检查，包括药敏试验（236 美元）；和其他费用。
治疗耐多药结核病的每位患者的住院费用是治疗南非敏感结核病的费用的 40 多倍。通过改进敏感结核病的管理并转向分散的门诊耐多药治疗模式，有可能大幅节省成本。
