title: Characteristics and costs of multidrug-resistant tuberculosis in-patient care in the United States, 2005-2007.
abstract: OBJECTIVE
  A population-based study of 135 multidrug-resistant tuberculosis (MDR-TB) patients reported to the Centers for Disease Control and Prevention (CDC) during 2005-2007 found 73% were hospitalized. We analyzed factors associated with hospitalization.
  
  
  METHODS
  We assessed statistically significant multivariable associations with US in-patient TB diagnosis, frequency of hospitalization, length of hospital stay, and in-patient direct costs to the health care system.
  
  
  RESULTS
  Of 98 hospitalized patients, 83 (85%) were foreign-born. Blacks, diabetics, or smokers were more likely, and patients with disseminated disease less likely, to receive their TB diagnosis while hospitalized. Patients aged ⩾65 years, those with the acquired immune-deficiency syndrome (AIDS), or with private insurance, were hospitalized more frequently. Excluding deaths, length of stay was greater for patients aged ⩾65 years, those with extensively drug-resistant TB (XDR-TB), those residing in Texas, those with AIDS, those who were unemployed, or those who had TB resistant to all first-line medications vs. others. Average hospitalization cost per XDR-TB patient (US$285 000) was 3.5 times that per MDR-TB patient (US$81 000), in 2010 dollars. Hospitalization episode costs for MDR-TB rank third highest and those for XDR-TB highest among the principal diagnoses.
  
  
  CONCLUSIONS
  Hospitalization was common and remains a critical care component for patients who were older, had comorbidities, or required complex management due to XDR-TB. MDR-TB in-patient costs are among the highest for any disease.
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Marks
authors.affiliation: International Center for AIDS Care and Treatment Programs, Columbia University New York, New York, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Hirsch-Moverman
authors.affiliation: Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, USA.
authors.forename: K
authors.initials: K
authors.lastname: Salcedo
authors.affiliation: Methodist Hospital Research Institute, Houston, Texas, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Graviss
authors.affiliation: Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, USA.
authors.forename: P
authors.initials: P
authors.lastname: Oh
authors.affiliation: Texas Department of State Health Services/University of Texas Health Science Center at Tyler, Texas, USA.
authors.forename: B
authors.initials: B
authors.lastname: Seaworth
authors.affiliation: Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Flood
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: L
authors.initials: L
authors.lastname: Armstrong
authors.affiliation: Texas Department of State Health Services/University of Texas Health Science Center at Tyler, Texas, USA.
authors.forename: L
authors.initials: L
authors.lastname: Armitige
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: S
authors.initials: S
authors.lastname: Mase
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D005791:Patient Care / Q000191:economics*; D014481:United States
chemical_list: D000995:Antitubercular Agents