Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany; Lung Clinic Grosshansdorf, Großhansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany.
University of Sassari, Sassari, Italy.
Int J Infect Dis. 2021 Feb;103:102-109. doi: 10.1016/j.ijid.2020.10.084. Epub 2020 Nov 3.
In 2019, new therapeutic recommendations for multidrug-resistant (MDR-) and extensively drug-resistant (XDR) tuberculosis (TB) were published by the WHO, advocating the use of oral drugs and stepwise composition of antibiotic regimens. To date, the economic consequences of those recommendations in low incidence settings have not been evaluated.
To assess the costs of applying the new recommendations against a set of 86 MDR-TB/XDR-TB strains, each with individual phenotypic drug resistance patterns, identified in 2018/2019 by the German National Reference Center for Mycobacteria.
Hospitalization costs as covered by German statutory health insurance and the loss of productivity due to illness were calculated using the most recent 2018 statistical data. Costs due to combining five agents in the intensive phase and costs of outpatient monitoring were determined by Monte-Carlo simulation covering all treatment options over an 18-month period. Drug costs were compared to those arising under the approach recommended by the WHO in 2016.
Hospitalization costs per MDR-TB patient were €30,152 and the mean costs of antimicrobials over a period of 18 months were €66,854 (range €20,671 to €187,444). Total treatment costs, including outpatient monitoring, were €73,551.56 per patient (range €30,114 to €145.878). In addition, we determined an average cost of €11,410.20 due to productivity loss over a period of 6 months sick leave. Despite a shortened minimum recommended treatment duration (18 versus 20 months), the estimated costs were 24.5% higher based on the 2019 recommendations as compared to the 2016 guideline version.
Higher costs for treating MDR-TB/XDR-TB in Germany are to be expected under the new WHO regimens. However, it must be determined whether treatment duration and costs associated with sick leave may be further reduced in the future through shorter hospital stays and earlier culture conversion.
2019 年，世界卫生组织（WHO）发布了针对耐多药（MDR）和广泛耐药（XDR）结核病（TB）的新治疗建议，主张使用口服药物和逐步组成抗生素方案。迄今为止，在低发病率环境下，尚未评估这些建议的经济后果。
评估在德国国家分枝杆菌参考中心 2018/2019 年鉴定的 86 株 MDR-TB/XDR-TB 菌株的新建议的应用成本，每株菌株都有单独的表型药物耐药模式。
使用德国法定健康保险涵盖的住院费用和因疾病导致的生产力损失，并使用 2018 年最新统计数据进行计算。通过蒙特卡罗模拟确定强化期联合使用五种药物的成本以及门诊监测的成本，涵盖了 18 个月内的所有治疗方案。比较了药物成本与 2016 年 WHO 建议的方法。
每例 MDR-TB 患者的住院费用为 30152 欧元，18 个月期间的抗微生物药物平均费用为 66854 欧元（范围为 20671 至 187444 欧元）。包括门诊监测在内，每位患者的总治疗费用为 73551.56 欧元（范围为 30114 至 145878 欧元）。此外，我们确定了 6 个月病假期间因生产力损失而导致的平均成本为 11410.20 欧元。尽管建议的最短治疗时间（18 个月与 20 个月）缩短，但与 2016 年指南版本相比，基于 2019 年建议的估计成本增加了 24.5%。
德国采用新的世卫组织方案治疗 MDR-TB/XDR-TB 的成本预计会更高。然而，必须确定在未来是否可以通过缩短住院时间和更早的培养转化来进一步减少治疗持续时间和与病假相关的成本。
