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Source publication
Objectives:
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.
Metho...
Contexts in source publication
Context 1
... (*information on hospitalization not available) 18 Female 24 Male 25 Female 25 Female 30 Female 36 Male 37 Male (*information on hospitalization not available) 52 Male Patients hospitalized Age Gender Age Gender Age Gender Age Gender ...
Context 2
... 28 Female 38 Male 48 Male 18 Male 29 Male 39 Male 49 Male 19 Female 29 Male 39 Female 50 Male 19 Female 31 Male 39 Male 52 Male 21 Male 32 Female 40 Male 53 Male 22 Male 32 Male 40 Male 55 Male 22 Female 33 Male 40 Female 57 Female 22 Female 35 Female 40 Male 60 Male 23 Male 35 Female 40 Male 68 Female 25 Female 35 Female 42 Male 71 Male 26 Male 35 Male 45 Male 73 Male 27 Male 37 Male 46 Female 74 Female 27 Male 37 Male 47 Male 80 Female 27 Female 38 Male 48 Male 87 Male MDR-TB Z Multidrug Resistant Tuberculosis. defined and calculated, if possible, based on the most recent available data in each case: ...
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Purpose
Cycloserine has been used in multidrug-resistant tuberculosis (MDR-TB) treatment since the 1950s. We evaluated the efficacy and safety of cycloserine and sought to clarify the role of cycloserine for treatment of simple MDR-TB, pre-extensively drug-resistant tuberculosis (pre-XDR-TB), and extensively drug-resistant tuberculosis (XDR-TB).
M...
The emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) strains is a major health problem for high Tuberculosis (TB) incidence countries. Therefore, it is of interest to identify antibiotic resistant bacteria by mismatch detection using DNA hybridization. We generated PCR products for five gen...
Abstract
Background
Russia, together with other former Soviet Union countries, is characterized by one of the highest burdens of drug-resistant tuberculosis. Published data on the drug-resistant tuberculosis for these countries are limited, and it is not clear whether current treatment regimens remain effective against constantly evolving drug-resi...
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Design: In this cross-sectional survey, a structured questionnaire was administered to eligible smear-positive patients in all 86 diagnostic and treatment centers of the country to...
Background
IMB-1402, Q203 and ND09759 analogs were found to have strong efficiency against Multi-drug-resistant tuberculosis (MDR-TB)/Extensively drug-resistant tuberculosis (XDR-TB) strains.
Objectives
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Citations
... Nano and microformulations were reported to enhance bioavailability and decrease degradation in the gastrointestinal tract, as well as to limit its side effects on the liver due to its high systematic exposure (Ahmed et al., 2008;Singh et al., 2015;Sung et al., 2009). Levofloxacin (LEV), one of drugs that were included in the second-line of TB treatment schedule (Ahmed et al., 2008;Diel et al., 2014;Kristin Reilly, 2014), has showed a wide bactericidal range and a great ability to penetrate cancellous and compact bone tissues. Therefore, it has a high efficiency to treat infectious bone (e.g. ...
Spinal tuberculosis (TB) represents around 1% of the recorded TB with a high mortality rate due to neurological complications and kyphosis. The current work aimed to develop a bioimplant scaffold to treat spinal TB disease. The scaffold is composed of a biocompatible semi-interpenetrating (semi-IPN) gelatin-based hydrogel incorporating mesoporous silica nanoparticles (MPS-NPs) loaded with rifampicin (RIF) and levofloxacin (LEV) to treat TB. The elastic modulus of the hydrogel was 7.18±0.78 MPa. Minimum inhibitory concentrations (MIC) value against Mycobacterium bovis for LEV-loaded and RIF-loaded MPS-NPs were 6.50 and 1.33 µm/ml, respectively.Sequential release of drugs was observed after 15 days. Loading of the MPS-NPs in the hydrogel matrix governed the amount of released drugs by prolonging the period of release up to 60 days. WST-1 test confirmed the biocompatibility and safety of the developed vertebral hydrogel bioimplant. Histological and immunohistochemistry micrographs showed the progress in healing process with the bioimplant. Besides, loading of LEV and RIF in the implants declined the presence of the giant macrophages clusters as compared to control groups. All the obtained results support the potential use of the developed vertebral hydrogel bioimplant as a scaffold with good mechanical and biocompatible properties along with a good ability to eradicate the TB pathogen.
... A study in South Africa suggested that about 70% drug-resistant TB costs were attributed to anti-TB drugs and hospitalization (6). In Germany and the United States, the costs of MDR-TB treatment were even much heavier (7,8). ...
Background
To date, the treatment success rate of Multidrug-resistant tuberculosis (MDR-TB) is low. The prolonged treatment course and expensive second-line anti-tuberculosis drugs (SLDs) for treating MDR-TB could lead to heavy financial expenditure. This economic barrier might result in poor adherence, lost to follow-up and treatment failure. Therefore, provision of financial support might improve treatment outcomes of MDR-TB. This study investigated the association between a subsidy policy and treatment outcomes of MDR-TB patients.
Methods
In this population-based, retrospective study, demographic, clinical characteristics, and the drug susceptibility profiles of all registered MDR-TB patients between 2011 and 2019 in Shanghai, China were collected. In total, 865 of 1016 patients were eligible for analysis, among which 70.6% (611/865) had treatment success. Information on the subsidies for MDR-TB treatment, which was in addition to the basic health insurance, were routinely recorded by the end of December 2021. Multivariate logistic regression adjusted for potential confounders was performed to evaluate the association between the situation of subsidies and treatment outcomes by estimating odds ratios (ORs) and 95% confidence intervals (CIs). The effect of greater/less subsidies on outcomes was further assessed using the median amount of financial support as cut-off points.
Results
During the study period, 74.1% (641/856) patients received subsidies for MDR-TB treatment. The median subsidies received across the treatment course was 15026 (Interquartile range, IQR, 7107–36001) Chinese Yuan (CNY), of which the reimbursement for SLDs were the major components. Those who had treatment success received significantly more subsidies (median, 17836 CNY) compared with patients with adverse outcomes (9794 CNY, P < 0.001). Benefiting from the subsidy policy was positively associated with treatment success, with an adjusted odds ratio (OR) equal to 2.95 (95% confidence interval [CI], 2.03–4.28). Among 641 patients who received subsidies, the OR comparing those with greater and less reimbursement was 1.74 (95% CI, 1.16–2.61). Additional adjustment for baseline drug-resistance did not alter these results.
Conclusions
Financial support was positively associated with better treatment outcomes among MDR-TB patients. Results in this study call for further financial assistance to facilitate appropriate medical care and to improve treatment outcomes of MDR-TB.
... For instance, now that programmatic management of drug-resistant TB has become ingrained in the Nigerian health system, oversight visits by the state team which is the most expensive home visit may no longer be required on a routine basis. The costs of Models A, B and C are $14,781, $12,113 and $7,572 respectively, which are markedly lower than the health sector costs of managing RR/MDR-TB in high income countries [9,30,31] but higher than the cost of treating RR/MDR-TB in similar low and middle income countries [6]. The main drivers of the differences in cost between the 20-month models of care and the shorter treatment regimen, are the duration of treatment and whether inpatient care was provided as part of care. ...
[This corrects the article DOI: 10.1371/journal.pone.0241065.].
... For instance, now that programmatic management of drug-resistant TB has become ingrained in the Nigerian health system, oversight visits by the state team which is the most expensive home visit may no longer be required on a routine basis. The costs of Models A, B and C are $14,781, $12,113 and $7,572 respectively, which are markedly lower than the health sector costs of managing RR/MDR-TB in high income countries [9,30,31] but higher than the cost of treating RR/MDR-TB in similar low and middle income countries [6]. The main drivers of the differences in cost between the 20-month models of care and the shorter treatment regimen, are the duration of treatment and whether inpatient care was provided as part of care. ...
Background
Globally, drug resistant tuberculosis (DR-TB) continues to be a public health threat. Nigeria, which accounts for a significant proportion of the global burden of rifampicin/multi-drug resistant-TB (RR/MDR-TB) had a funding gap of $168 million dollars for TB treatment in 2018. Since 2010, Nigeria has utilized five different models of care for RR/MDR-TB (Models A-E); Models A, B and C based on a standardized WHO-approved treatment regimen of 20–24 months, were phased out between 2015 and 2019 and replaced by Models D and E. Model D is a fully ambulatory model of 9–12 months during which a shorter treatment regimen including a second-line injectable agent is utilized. Model E is identical to Model D but has patients hospitalized for the first four months of care while Model F which is to be introduced in 2020, is a fully ambulatory, oral bedaquiline-containing shorter treatment regimen of 9–12 months. Treatment models for RR/MDR-TB of 20–24 months duration have had treatment success rates of 52–66% while shorter treatment regimens have reported success rates of 85% and above. In addition, replacing the second-line injectable agent in a shorter treatment regimen with bedaquiline has been found to further improve treatment success in patients with fluoroquinolone-susceptible RR/MDR-TB.
Reliable cost data for RR/MDR-TB care are limited, specifically costs of models that utilize shorter treatment regimens and which are vital to guide Nigeria through the provision of RR/MDR-TB care at scale. We therefore conducted a cost analysis of shorter treatment regimens in use and to be used in Nigeria (Models D, E and F) and compared them to three models of longer duration utilized previously in Nigeria (Models A, B and C) to identify any changes in cost from transitioning from Models A-C to Models D-F and opportunities for cost savings.
Methods
We obtained costs for TB diagnostic and monitoring tests, in-patient and out-patient care from a previous study, inflated these costs to 2019 NGN and then converted to 2020 USD. We obtained other costs from the average of six health facilities and drug costs from the global drug facility. We modeled treatment on strict adherence to two Nigerian National guidelines for programmatic and clinical management of drug-resistant tuberculosis.
Results
We estimated that the total costs of care from the health sector perspective for Models D, E and F were $4,334, $7,705 and $3,420 respectively. This is significantly lower than the costs of Models A, B and C which were $14,781, $12, 113, $7,572 respectively.
Conclusion
Replacing Models A–C with Models D and E reduced the costs of RR/MDR-TB care in Nigeria by approximately $5,470 (48%) per patient treated and transitioning from Models D and E to Model F would result in further cost savings of $914 to $4,285 (21 to 56%) for every patient placed on Model F. If the improved outcomes of patients managed using bedaquiline-containing shorter treatment regimens in other countries can be attained in Nigeria, Model F would be the recommended model for the scale up of RR/MDR-TB care in Nigeria.
... This is explained by longer treatment duration, more costly drugs, and more adverse events. The last analysis of MDR-TB treatment costs in Germany was published in 2014 [4], referring to the 2011 WHO guidelines [5] when bedaquiline and delamanid were not yet available. In the meantime, the 2019 consolidated WHO guidelines for treating MDR-/XDR-TB [2] have replaced the former 2016 recommendations [3]. ...
... While the cost to treat MDR-and XR-TB was evaluated in the past [4,9] the economic consequences of the new WHO recommendations have not yet been systematically studied. We here carried out a cost analysis to address this important issue by applying the new WHO and ATS/CDC/ERS/IDSA guidelines to patients infected with multidrug-resistant Mycobacterium tuberculosis strains isolated in Germany between June 2018 and September 2019 and sent to the National Reference Center for Mycobacteria in Borstel, Germany. ...
Background
In 2019, new therapeutic recommendations for multidrug-resistant (MDR-) and extensively drug-resistant (XDR) tuberculosis (TB) were published by the WHO, advocating the use of oral drugs and stepwise composition of antibiotic regimens. To date, the economic consequences of those recommendations in low incidence settings have not been evaluated.
Objective
To assess the costs of applying the new recommendations against a set of 86 MDR-TB/XDR-TB strains with, each with individual phenotypic drug resistance patterns, identified in 2018/2019 by the German National Reference Center for Mycobacteria.
Methods
Hospitalization costs as covered by German statutory health insurance, and the loss of productivity due to illness were calculated using the most recent 2018 statistical data. Costs due to combining five agents in the intensive phase and costs of outpatient monitoring were determined by Monte-Carlo simulation covering all treatment options over an 18-month period. Drug costs were compared to those arising under the approach recommended by the WHO in 2016.
Results
Hospitalization costs per MDR-TB patient were Є30,152 and the mean costs of antimicrobials over a period of 18 months were Є66,854 (range Є20,671 to Є187,444). Total treatment costs, including outpatient monitoring, were Є73,551.56 per patient (range Є30,114 to Є145.878). In addition, we determined an average cost of Є11,410.20 due to productivity loss over a period of 6 months sick leave. Despite a shortened minimum recommended treatment duration (18 versus 20 months), the estimated costs were 24.5% higher based on the 2019 recommendations as compared to the 2016 guideline version.
Conclusion
Higher costs for treating MDR-TB/XDR-TB in Germany are to be expected under the new WHO regimens. However, it must be determined whether treatment duration and costs associated with sick leave may be further reduced in the future through shorter hospital stays and earlier culture conversion.
... Total costs and OOP expenditures were also obtained directly from the NRCMS database and selected as the main outcome variables, which were key indicators to evaluate the direct medical economic burden to inpatients covered by medical insurance [19,20]. As the NRCMS has covered almost all rural residents in China and the database is relatively complete and accurate, our data were representative in indicating the characteristics of TB hospitalization costs in rural China. ...
Background:
Tuberculosis (TB) still causes high economic burden on patients in China, especially for rural patients. Our study aims to explore the risk factors associated with the high costs for TB inpatients in rural China from the aspects of inpatients' socio-demographic and institutional attributes.
Methods:
Generalized linear models were utilized to investigate the factors associated with TB inpatients' total costs and out-of-pocket (OOP) expenditures. Quantile regression (QR) models were applied to explore the effect of each factor across the different costs range and identify the risk factors of high costs.
Results:
TB inpatients with long length of stay and who receive hospitalization services cross provincially, in tertiary and specialized hospitals were likely to face high total costs and OOP expenditures. QR models showed that high total costs occurred in Dingyuan and Funan Counties, but they were not accompanied by high OOP expenditures.
Conclusions:
Early diagnosis, standard treatment and control of drug-resistant TB are still awaiting for more efforts from the government. TB inpatients should obtain medical services from appropriate hospitals. The diagnosis and treatment process of TB should be standardized across all designated medical institutions. Furthermore, the reimbursement policy for migrant workers who suffered from TB should be ameliorated.
... Additionally, the costs of treating patients with MDR-TB and XDR-TB are very high [2,8]. ...
... Infection with a drug-resistant strain, smoking, HIV infection, and cavitation [1,8]. Most recurrences occur between 6 months and two years of completing treatment [11][12][13][14]. ...
Treating tuberculosis (TB) requires a multidrug course of treatment lasting 6 months, or longer for drug-resistant TB, which is difficult to complete and often not well tolerated. Treatment failure and recurrence after end-of-treatment can have devastating consequences, including progressive debilitation, death, the transmission of Mycobacterium tuberculosis - the infectious agent responsible for causing TB - to others, and may be associated with the development of drug-resistant TB. The burden on health systems is important, with severe economic consequences. Vaccines have the potential to serve as immunotherapeutic adjuncts to antibiotic treatment regimens for TB. A therapeutic vaccine for TB patients, administered towards completion of a prescribed course of drug therapy or at certain time(s) during treatment, could improve outcomes through immune-mediated control and even clearance of bacteria, potentially prevent re-infection, and provide an opportunity to shorten and simplify drug treatment regimens. The preferred product characteristics (PPC) for therapeutic TB vaccines described in this document are intended to provide guidance to scientists, funding agencies, public and private sector organizations developing such vaccine candidates. This document presents potential clinical end-points for evidence generation and discusses key considerations about potential clinical development strategies.
... Higher HIV and substance use prevalence among younger age groups may also account for some of the hospitalization disparity. Unfortunately, multidrug resistance was not accounted for in this study as this may also be the age group where it is highest [33]. Further studies to explore age-specific correlates of TB hospitalization and what appears to be an unexplained increase in hospitalizations among younger age groups are required. ...
Background:
Few studies have explored the relative burden and trends in pulmonary (PTB) vs. extra-pulmonary (EPTB) tuberculosis in the United States using a nationally representative sample.
Methods:
This study examined trends in hospitalization rates, length-of-stay (LOS), in-hospital mortality and inflation-adjusted charges, for PTB vs. EPTB using the Nationwide/National Inpatient Sample (NIS) from 1998 to 2014. Descriptive and multivariable analyses (linear, negative binomial and logistic) were utilized adjusting for demographics, co-morbidity and hospital characteristics.
Results:
During the study period there were a survey-adjusted, estimated 258,631 PTB (75.5%), 76,476 EPTB (22.3%) and 7552 concurrent PTB and EPTB (2.2%) discharges. Whites accounted for 27.6% of PTB, 21.9% of EPTB and 17.6% of concurrent discharges; and self-pay or no insurance accounted for 22.2%, 18.4%, and 25.9%, respectively. EPTB was more common among blacks (22.5%), and combined TB more common among Hispanics (24.8%). Mean LOS was 11.4 days, 13.2 days, and 19.5 days; with mean nominal charges of $48,031, $62,255, and $89,364 for PTB, EPTB and combined TB respectively. Inpatient mortality for all three groups was approximately 5.7%. Miliary TB and TB of meninges and central nervous system were positively associated with mortality (odds ratios of 2.44 and 2.11, respectively), as was alcohol abuse (OR 1.21). Trend analyses showed decreased hospitalizations for all TB types, no change in LOS trends, decreased mortality for PTB and ETB and increased charges for PTB and ETB from 1998 to 2014. Increased utilization, higher charges and higher risk of mortality (to some extent) among the EPTB cases warrant improved methods for screening, diagnosis and treatment.
Conclusion:
Though rates of TB hospitalization are declining, EPTB is becoming relatively more common and is more costly compared to pulmonary TB. Screening methods that focus on identification of ETB contrary to current practice guidelines are needed to aid ETB case finding.
... In countries such as the United Kingdom and Germany, all patients diagnosed with TB receive DST to the full range of available drugs. 76,77 In these settings, treatment is often individualised based on DST, avoiding the use of ineffective, potentially toxic drugs and maximising the chances of cure. Indeed, treatment success has been reported to be above 80% in recent reports from the Netherlands and Canada. ...
The drug-resistant tuberculosis (DR-TB) cascade-from estimated or incident cases to numbers successfully treated or disease-free survival-has long been characterised by sharp declines at each step in the cascade. The losses along the cascade vary across different settings, and the reasons why some countries have a higher burden of DR-TB are complex and multifactorial; broadly, weak health systems, inadequate financing and poverty all impact differential access to DR-TB care. Within a human rights framework that mandates the right to health and the right to benefit from scientific progress, the aim of this review is to focus on describing inequities in access to DR-TB care at critical points in the cascade.
... Diel et al. simulated the cost to be between s82,150 ($85,436) and s108,733 ($113,082). 12 Marks et al. estimated US costs to be $134,000 per patient with MDR-TB and $430,000 per patient XDR-TB. 13 Most of these studies involved inpatient and outpatient costs as well as estimation of productivity losses. ...
Background
Private healthcare is choice of point of care for 70% of Indians. Multidrug resistant tuberculosis (MDR-TB) treatment is costly and involves duration as long as 2 years.
Aim
To estimate costs to patients undergoing treatment for MDR-TB.
Methods
A health-economics questionnaire was administered to 50 consecutive patients who successfully completed ambulatory private treatment for MDR-TB. Direct costs included drug costs, investigations, consultation fees, travel costs, hospitalisation and invasive procedures and cost prior to presentation to us. Indirect costs included loss of income.
Results
Of our cohort of 50 patients, 36 had pulmonary TB while 14 had extra-pulmonary TB (EPTB). 40 had MDR-TB and 10 had XDR-TB. There were 15 males and 35 females. Mean age was 30 years (range 16–61 years). Treatment cost for pulmonary MDR-TB averaged $5723 while it averaged $8401 for pulmonary XDR-TB and $5609 for EPTB. The major expense was due to drug costs (37%) while consultation fees were only 5%. Annual individual income for the cohort ranged from $0 to $63,000 (mean $11,430). On average, the cost of treatment ranged from 2.56% to 180.34% of the annual family income. 34/50 (68%) had total costs greater than 20% of annual family income and 39/50 (78%) had total costs greater than 10% of annual family income. The number of patients with total costs >40% of total family income was 22.
Conclusion
MDR-TB in the private sector results in “catastrophic health costs”. Financial and social support is essential for patients undergoing treatment for MDR-TB.
