title: Cost of multi drug resistance tuberculosis in Germany.
abstract: OBJECTIVE
  4220 new cases of tuberculosis (TB) were reported in Germany in 2012; of those, 65 cases were multidrug-resistant TB (MDR-TB) or extensively multidrug-resistant TB (XDR-TB) cases. However, there is only limited information on the economic consequences of drug resistance patterns on the treatment costs of MDR-and XDR-TB patients.
  
  
  METHODS
  On the basis of drug susceptibility of the single MDR-TB/XDR-TB strains the direct medical costs of suitable therapies were calculated according to the current guidelines of the World Health Organization (WHO) and those of the German Central Committee against Tuberculosis. These costs were combined with hospital and outpatients monitoring costs and followed the most recent German invoicing system and health statistics. Total drug and monitoring costs and were determined by Monte-Carlo simulation comprising all different options.
  
  
  RESULTS
  According to this, the mean drug costs were €51,113.22 (range €19,586.14 to €94,767.90). The weighted costs for hospitalization were €26,000.76 per patient compared to only €2,192.13 for primary outpatients; the total treatment costs of MDR-TB amounted to €64,429.23. These are joined by the costs due to loss of productivity, varying between €17,721.60 and €44,304. From a societal perspective, the total cost per MDR-TB/XDR-TB case reach an amount between €82,150 and €108,733 per case, respectively.
  
  
  CONCLUSIONS
  Cost analyses based on strain resistance patterns allow more reliable estimates of the real costs of treating MDR-TB/XDR-TB than do methods that ignore this factor. Advantageously, they demonstrate the economic impact of drug-resistant TB in low-incidence countries. Costs of productivity loss is of new importance because of the length of MDR-XDR therapy, but its true share of total costs has still to be determined.
authors.affiliation: Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany. Electronic address: roland.diel@epi.uni-kiel.de.
authors.forename: R
authors.initials: R
authors.lastname: Diel
authors.affiliation: Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Nienhaus
authors.affiliation: Department of Accounting and Finance, University of Hohenheim, Stuttgart, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Lampenius
authors.affiliation: National Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Rüsch-Gerdes
authors.affiliation: National Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Richter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000191:economics* / Q000627:therapeutic use; D017281:Cost of Illness; D016527:Drug Costs / Q000706:statistics & numerical data; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Cost analysis; MDR-TB; Monte Carlo simulation; Strain resistance; Tuberculosis; XDR-TB