The value of effective public tuberculosis treatment: an analysis of opportunity costs associated with multidrug resistant tuberculosis in Latvia

Abstract

BackgroundA challenge to effective protection against tuberculosis is to sustain expensive and complex treatment public programs. Potential consequences of program failure include acquired drug resistance, poor patient outcomes, and potentially much higher system costs, however. In contrast, effective efforts have value illustrated by impacts they prevent. We compared the healthcare costs and treatment outcomes among multidrug-resistant tuberculosis (MDR-TB) and non MDR-TB patients in Latvia to identify benefits or costs associated with both.MethodsWe measured and compared costs, healthcare utilization, and outcomes for patients who began treatment through Latvia’s TB control program in 2002 using multivariate regression analysis and negative binomial regression.ResultsWe analyzed data for 92 MDR-TB and 54 non MDR-TB patients. Most (67%) MDR-TB patients had history of prior tuberculosis treatment. MDR-TB was associated with lower cure rates (71% vs. 91%) and greater resource utilization. MDR-TB treatment cost almost $20,000 more than non MDR-TB.ConclusionUp to 2/3 of MDR-TB treated in our sample was preventable at a potential savings of over $1.3 million in healthcare resources as well as substantial individual health.

Estimating the burden of antimicrobial resistance: a systematic literature review

“…Using Israeli patient data from a national registry, MDR was found to be significantly associated with TB-related death [OR = 2.83(95% CI; 1.70-4.72), p < 0.001], using a logistic regression approach [ 148 ]. Healthcare system burden: MDR-TB was estimated to cost the South African healthcare system $6728 excess per case, $33,291 total per case in Latvia and $86,321 total per case in Germany using an evidence synthesis approach [ 135 – 137 ]. These studies included factors such as length of stay, drug costs and services consumed (varying between studies).…”

Costs to Health Services and the Patient of Treating Tuberculosis: A Systematic Literature Review

“…However, the importance of outpatient costs varied substantially among country income groups. In HICs, only five of 19 studies reported any outpatient costs [ 24 , 38 – 41 ]. Of the ten UMIC studies that reported these costs, Argentina and South Africa had the lowest values of around US$20 per patient [ 42 – 44 ] and Botswana the highest at US$658 per patient [ 45 ].…”

“…Lower cost treatment within groups was observed where primarily ambulatory models of care are adopted, with hospitalisation being a major driver of total cost. Across DS-TB treatment, there is a clear reduction in costs over time due to the extent of hospitalisation decreasing as countries moved towards ambulatory DOTS, although in countries such as Germany, Spain, the USA and Latvia high hospitalisation costs were still reported between 2010 and 2013 [ 24 , 41 , 52 , 65 ] (DS-TB patients were hospitalised for an average of 115 and 72 days in Latvia and the USA, respectively). Care should therefore be taken when using costs from this review to estimate current costs for any one setting to ensure that the cost applied reflects the current mix of hospitalisation and ambulatory treatment.…”

Final treatment outcomes of multidrug- and extensively drug-resistant tuberculosis patients in Latvia receiving delamanid-containing regimens

“…Latvia is a high-priority country in the fight against tuberculosis (TB) in Europe, with an estimated TB incidence of 41 per 100 000 in 2015 [1]. In spite of an improving TB control programme [2] and cure rates reaching 80% for new and retreatment TB cases notified in 2014, multidrug-resistant (MDR-) TB (defined as TB resistant to rifampicin and isoniazid) rates in Latvia remain high [1]. An estimated 8% of new cases and 30% of retreatment TB cases were at least rifampicin-resistant (RR) in 2015 [1].…”