Cox Helen, Ramma Lebogang, Wilkinson Lynne, Azevedo Virginia, Sinanovic Edina
Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Health Economics Unit, University of Cape Town, Cape Town, South Africa.
Trop Med Int Health. 2015 Oct;20(10):1337-45. doi: 10.1111/tmi.12544. Epub 2015 Jun 1.
The high cost of rifampicin-resistant tuberculosis (RR-TB) treatment hinders treatment access. South Africa has a high RR-TB burden, and national policy outlines decentralisation to improve access and reduce costs. We analysed health system costs associated with RR-TB treatment by drug resistance profile and treatment outcome in a decentralised programme.
Retrospective, routinely collected patient-level data were combined with unit cost data to determine costs for each patient in a cohort treated between January 2009 and December 2011. Drug costs were based on recommended regimens according to drug resistance and treatment duration. Hospitalisation costs were estimated based on admission/discharge dates, while clinic visit and diagnostic/monitoring costs were estimated according to recommendations and treatment duration. Missing data were imputed.
Among 467 patients (72% HIV infected), 49% were successfully treated. Treatment was initiated in primary care for 62%, with the remainder as inpatients. The mean cost per patient treated was $7916 (range 260-87,140), ranging from $5369 among patients who did not complete treatment to $23,006 for treatment failure. Mean cost for successful treatment was $8359 (2585-32,506). Second-line drug resistance was associated with a mean cost of $15,567 vs. $6852 for only first-line resistance, with the major cost difference due to hospitalisation. Costs are reported in 2013 USD.
RR-TB treatment cost was high and varied according to treatment outcome. Despite decentralisation, hospitalisation remained a significant cost, particularly among those with more extensive resistance and those with treatment failure. These cost estimates can be used to model the impact of new interventions to improve patient outcomes.
耐利福平结核病（RR-TB）治疗成本高昂，阻碍了治疗的可及性。南非RR-TB负担沉重，国家政策概述了权力下放以改善可及性并降低成本。我们在一个权力下放的项目中，按耐药谱和治疗结果分析了与RR-TB治疗相关的卫生系统成本。
将回顾性、常规收集的患者层面数据与单位成本数据相结合，以确定2009年1月至2011年12月期间治疗的一组患者中每位患者的成本。药品成本基于根据耐药性和治疗持续时间推荐的治疗方案。住院成本根据入院/出院日期估算，而门诊就诊和诊断/监测成本根据建议和治疗持续时间估算。缺失数据进行了插补。
在467例患者（72%感染HIV）中，49%成功治愈。62%的患者在初级保健机构开始治疗，其余为住院患者。每位接受治疗患者的平均成本为7916美元（范围260 - 87,140美元），未完成治疗的患者平均成本为5369美元，治疗失败的患者平均成本为23,006美元。成功治疗的平均成本为8359美元（2585 - 32,506美元）。二线耐药的平均成本为15,567美元，仅一线耐药的平均成本为6852美元，主要成本差异在于住院费用。成本以2013年美元报告。
RR-TB治疗成本高昂且因治疗结果而异。尽管权力下放，但住院治疗仍是一项重大成本，特别是在耐药范围更广和治疗失败的患者中。这些成本估计可用于模拟新干预措施对改善患者结局的影响。
