Tuberculosis Costs in Spain and Related Factors.
OBJECTIVE
To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors.


METHODS
Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals.


RESULTS
319 patients were included with a mean age of 56.72±20.79 years. The average cost was €10,262.62±14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR=96.8; CI 29-472), sensitivity testing (OR=4.34; CI 1.71-12.1), chest CT (OR= 2.25; CI 1.08-4.77), DOT (OR=20.76; CI 4.11-148) and sick leave (OR=26,9; CI 8,51-122) showed an independent association with cost.


CONCLUSIONS
Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required.
Unidad de Gestión Clínica, Neumología, Hospital San Agustín, Avilés, Asturias, España; Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España. Electronic address: josegubl@gmail.com.
José Antonio
JA
Gullón
Unidad de Gestión Clínica, Neumología, Hospital San Agustín, Avilés, Asturias, España; Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España.
José María
JM
García-García
Unidad de Gestión Clínica, Neumología, Hospital San Agustín, Avilés, Asturias, España.
Manuel Ángel
MÁ
Villanueva
Unidad de Gestión Clínica, Neumología, Hospital San Agustín, Avilés, Asturias, España.
Fernando
F
Álvarez-Navascues
Fundación Respira, Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España; Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, España.
Teresa
T
Rodrigo
Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, España.
Martí
M
Casals
Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España; Hospital Universitario de Pontevedra, Pontevedra, España.
Luis
L
Anibarro
Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España; Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
Marta María
MM
García-Clemente
Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España; Hospital Universitario Val D'Hebrón, Barcelona, España.
María Ángeles
MÁ
Jiménez
Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España; Hospital Sierrallana, Torrelavega, Cantabria, España.
Ana
A
Bustamante
Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España; Hospital Universitario Lucus Augusti, Lugo, España.
Antón
A
Penas
Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España; Complejo Hospitalario Dr. Negrín, Las Palmas de Gran Canaria, España.
José Antonio
JA
Caminero
Agencia de Salud Pública de Barcelona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, España.
Joan
J
Caylà
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use; D016001:Confidence Intervals; D017281:Cost of Illness; D003955:Diagnostic Tests, Routine / Q000191:economics; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012737:Sex Factors; D018582:Sick Leave / Q000191:economics / Q000706:statistics & numerical data; D013030:Spain / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D055815:Young Adult
D000995:Antitubercular Agents
Cost analysis; Costes; Hospital income; Ingreso hospitalario; Tuberculosis