What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa?
BACKGROUND
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.


METHODS
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.


RESULTS
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%.


CONCLUSIONS
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.
Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Anil
A
Pooran
Elize
E
Pieterson
Malika
M
Davids
Grant
G
Theron
Keertan
K
Dheda
D000995:Antitubercular Agents / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D016527:Drug Costs; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D009169:Mycobacterium tuberculosis; D013019:South Africa; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*
D000995:Antitubercular Agents