title: Treatment practices, outcomes, and costs of multidrug-resistant and extensively drug-resistant tuberculosis, United States, 2005-2007.
abstract: To describe factors associated with multidrug-resistant (MDR), including extensively-drug-resistant (XDR), tuberculosis (TB) in the United States, we abstracted inpatient, laboratory, and public health clinic records of a sample of MDR TB patients reported to the Centers for Disease Control and Prevention from California, New York City, and Texas during 2005-2007. At initial diagnosis, MDR TB was detected in 94% of 130 MDR TB patients and XDR TB in 80% of 5 XDR TB patients. Mutually exclusive resistance was 4% XDR, 17% pre-XDR, 24% total first-line resistance, 43% isoniazid/rifampin/rifabutin-plus-other resistance, and 13% isoniazid/rifampin/rifabutin-only resistance. Nearly three-quarters of patients were hospitalized, 78% completed treatment, and 9% died during treatment. Direct costs, mostly covered by the public sector, averaged $134,000 per MDR TB and $430,000 per XDR TB patient; in comparison, estimated cost per non-MDR TB patient is $17,000. Drug resistance was extensive, care was complex, treatment completion rates were high, and treatment was expensive.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Marks
authors.forename: Jennifer
authors.initials: J
authors.lastname: Flood
authors.forename: Barbara
authors.initials: B
authors.lastname: Seaworth
authors.forename: Yael
authors.initials: Y
authors.lastname: Hirsch-Moverman
authors.forename: Lori
authors.initials: L
authors.lastname: Armstrong
authors.forename: Sundari
authors.initials: S
authors.lastname: Mase
authors.forename: Katya
authors.initials: K
authors.lastname: Salcedo
authors.forename: Peter
authors.initials: P
authors.lastname: Oh
authors.forename: Edward A
authors.initials: EA
authors.lastname: Graviss
authors.forename: Paul W
authors.initials: PW
authors.lastname: Colson
authors.forename: Lisa
authors.initials: L
authors.lastname: Armitige
authors.forename: Manuel
authors.initials: M
authors.lastname: Revuelta
authors.forename: Kathryn
authors.initials: K
authors.lastname: Sheeran
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use; D015897:Comorbidity; D004359:Drug Therapy, Combination; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000266:history; D005260:Female; D017048:Health Care Costs; D049674:History, 21st Century; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000266:history; D014481:United States / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents
keywords: TB; Tuberculosis; United States; cost; drug resistance; extensively drug-resistant tuberculosis; multidrug-resistant tuberculosis; outcomes; treatment practices; tuberculosis and other mycobacteria
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