An effectiveness and cost analysis of presumptive treatment for Mycobacterium tuberculosis.
BACKGROUND
Delay in treatment of tuberculosis has contributed to both the spread of tuberculosis and its case fatality rate.


METHODS
Decision analysis was used to examine the effectiveness and cost of presumptive treatment in patients evaluated for tuberculosis.


RESULTS
Over a range of assumptions, empiric antituberculous therapy for acid-fast bacillus smear-positive persons lowers mortality and cost per person evaluated when available rapid diagnostic laboratory methods for tuberculosis are used. In contrast, the average cost per life saved by giving presumptive treatment to all acid-fast bacillus smear- and HIV-negative patients exceeds. $1 million. Empiric treatment for HIV-infected patients with acid-fast bacillus-negative smears decreases average mortality by 2% at an additional cost of $8000 per life saved. When the prevalence of multiple-drug resistance exceeds 9.6%, presumptive drug-resistant therapy for acid-fast bacillus smear-positive patients, rather than the initial four-drug regimen recommended for much of the United States, minimizes both mortality and costs.


CONCLUSIONS
Empiric antituberculous therapy often minimizes average mortality and cost for patients evaluated for tuberculosis when rapid diagnostic methods are used.
Brewer
T F
TF
Channing Laboratory, Brigham and Women's Hospital, Boston, MA, USA.
Heymann
S J
SJ
Ettling
M
M
D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003663:Decision Trees; D018432:Drug Resistance, Multiple; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000191:economics*
D000995:Antitubercular Agents