Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa.
PLoS One. 2013;8(1):e54587. doi: 10.1371/journal.pone.0054587. Epub 2013 Jan 18.
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.
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.
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 $6930 (26%) per case and reduce the total amount spent on DR-TB by ~7%.
CONCLUSION/SIGNIFICANCE: Although DR-TB forms a very small proportion of the total case burden it consumes a disproportionate and substantial amount of South Africa's total annual TB budget. These data inform rational resource allocation and selection of management strategies for DR-TB in high burden settings.
耐药结核病（DR-TB）正在破坏南非的结核病控制。然而，尽管决策者合理规划和分配资源以及为未来的成本效益分析提供信息都需要此类信息，但在高负担地区治疗耐多药结核病的成本几乎没有任何数据。
我们根据国家南非结核病指南，从国家结核病规划的角度，利用已发表的临床结局数据，分析了基于美国 2011 年美元（$）的药物敏感结核病（DS-TB）、耐多药结核病（MDR-TB）和广泛耐药结核病（XDR-TB）的诊断和治疗的比较成本。
假设遵守国家耐多药结核病管理指南，每例 XDR-TB 患者的费用为 26,392 美元，是 MDR-TB（$6772）的四倍，是药物敏感结核病（$257）的 103 倍。尽管 DR-TB 仅占病例负担的 2.2%，但它消耗了 2011 年国家结核病预算（2.18 亿美元）的~32%。DR-TB 成本的 45%和 25%分别归因于抗结核药物和住院治疗。XDR-TB 占总耐多药结核病诊断和治疗费用的 28%。实验室检测和抗结核药物占 MDR-TB 费用的大部分（71%），而住院和抗结核药物费用占 XDR-TB 费用的大部分（92%）。分散的 XDR-TB 治疗方案可能使每例病例的成本降低 6930 美元（26%），并使耐多药结核病的总支出减少约 7%。
结论/意义：尽管 DR-TB 构成了总病例负担的很小一部分，但它消耗了南非结核病总年度预算的不成比例且相当大的一部分。这些数据为高负担地区的耐多药结核病提供了合理的资源分配和管理策略选择的信息。
