Specialized therapy and drug-susceptibility testing (DST) are argued to be too costly for patients sick with multidrug-resistant tuberculosis (MDR-TB) in poor countries. Yet, nearly 95% of 160 tuberculosis patients from three districts of northern Lima who failed directly observed standardized short-course chemotherapy (DOT-SCC) between 1996 and 1998, were sick with TB caused by strains of M. tuberculosis resistant to at least isoniazid and rifampin, or MDR-TB. Among the first cohort of 100 patients receiving community-based, individualized treatment for MDR-TB, more than half had received three or more previous DOT-SCC regimens. At least half of the patients who then received MDR-TB treatment had clinical histories demonstrating the acquisition of further resistance to antituberculous drugs in the interval during which they received DOT-SCC. The cost of medications for two-drug resistant tuberculosis is considerably lower than the cost for medications to treat four- and five-drug resistant disease (Figure 1). This paper will calculate costs of managing MDR-TB under two scenarios. In the first, costs will be calculated for patients who fail three or more rounds of DOT-SCC, undergo drug-susceptibility testing, and then appropriate treatment for MDR-TB. In the second scenario, patients who appear to be failing the first DOT-SCC regimen would undergo drug-susceptibility testing, and then appropriate treatment for MDR-TB. Results may be used to determine the most cost-efficient MDR-TB treatment paradigms in a community with elevated levels of the disease. Figure 1. Cost for 18-month regimen for the treatment of 2-, 4-, and 5-drug-resistant TB (6 months for the injectable)
Learning Objectives: Participants will be able to enumerate the factors that determine cost of treatment for MDR-TB and compare the cost efficacy of repeated standardized regimens in patients failing therapy to that of triage to individualized therapy after failure of the standardized regimen
Keywords: Tuberculosis, Cost Issues
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.