Treatment Practices, Outcomes, and Costs of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, United States, 2005–2007

Emerging Infectious Diseases (Impact Factor: 6.75). 05/2014; 20(5):812-21. DOI: 10.3201/eid2005.131037
Source: PubMed


To describe factors associated with multidrug-resistant (MDR), including extensively-drug-resistant (XDR), tuberculosis (TB) in the United States, we abstracted inpatient, laboratory, and public health clinic records of a sample of MDR TB patients reported to the Centers for Disease Control and Prevention from California, New York City, and Texas during 2005-2007. At initial diagnosis, MDR TB was detected in 94% of 130 MDR TB patients and XDR TB in 80% of 5 XDR TB patients. Mutually exclusive resistance was 4% XDR, 17% pre-XDR, 24% total first-line resistance, 43% isoniazid/rifampin/rifabutin-plus-other resistance, and 13% isoniazid/rifampin/rifabutin-only resistance. Nearly three-quarters of patients were hospitalized, 78% completed treatment, and 9% died during treatment. Direct costs, mostly covered by the public sector, averaged $134,000 per MDR TB and $430,000 per XDR TB patient; in comparison, estimated cost per non-MDR TB patient is $17,000. Drug resistance was extensive, care was complex, treatment completion rates were high, and treatment was expensive.

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Available from: Edward A Graviss, Jun 19, 2014
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    • "For the US, Rajbhandary et al. analyzed the inpatient costs of 13 MDR-TB patients enrolled in a CDC study in 1995/1996 and estimated the remaining costs from a societal perspective [28]. Marks et al. [29], in their impressive population-based sample of 134 patients that comprised 36% (130/364) of all MDR-TB and 56% (5/9) of all XDR-TB cases reported in the United States during 2005e2007, calculated direct-plus-productivity-loss costs of USD 260,000 per MDR-TB patients and USD 554,000 per Table 5 GKV costs of diagnosing MDR-TB and monitoring MDR-TB treatment (in V). "
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    ABSTRACT: 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. Methods: On the basis of drug susceptibility of the single MDR-TB/XDR-TB strains the direct medical costs of suitable therapies were calculated according to the current guidelines of the World Health Organization (WHO) and those of the German Central Committee against Tuberculosis. These costs were combined with hospital and outpatients monitoring costs and followed the most recent German invoicing system and health statistics. Total drug and monitoring costs and were determined by Monte-Carlo simulation comprising all different options. Results: According to this, the mean drug costs were €51,113.22 (range €19,586.14 to €94,767.90). The weighted costs for hospitalization were €26,000.76 per patient compared to only €2,192.13 for primary outpatients; the total treatment costs of MDR-TB amounted to €64,429.23. These are joined by the costs due to loss of productivity, varying between €17,721.60 and €44,304. From a societal perspective, the total cost per MDR-TB/XDR-TB case reach an amount between €82,150 and €108,733 per case, respectively. Conclusion: Cost analyses based on strain resistance patterns allow more reliable estimates of the real costs of treating MDR-TB/XDR-TB than do methods that ignore this factor. Advantageously, they demonstrate the economic impact of drug-resistant TB in low-incidence countries. Costs of productivity loss is of new importance because of the length of MDR-XDR therapy, but its true share of total costs has still to be determined.
    Respiratory Medicine 11/2014; 108(11). DOI:10.1016/j.rmed.2014.09.021 · 3.09 Impact Factor
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    • "Extensive resistance: it defines the ability of organisms to withstand the inhibitory effects of at least one or two most effective antimicrobial drugs. Also termed as XDR, this seemed to arise in patients after they have undergone a treatment with first line drugs, for example, XDR-TB resistance against fluoroquinolone [35, 36]. "
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    ABSTRACT: The resistance among various microbial species (infectious agents) to different antimicrobial drugs has emerged as a cause of public health threat all over the world at a terrifying rate. Due to the pacing advent of new resistance mechanisms and decrease in efficiency of treating common infectious diseases, it results in failure of microbial response to standard treatment, leading to prolonged illness, higher expenditures for health care, and an immense risk of death. Almost all the capable infecting agents (e.g., bacteria, fungi, virus, and parasite) have employed high levels of multidrug resistance (MDR) with enhanced morbidity and mortality; thus, they are referred to as "super bugs." Although the development of MDR is a natural phenomenon, the inappropriate use of antimicrobial drugs, inadequate sanitary conditions, inappropriate food-handling, and poor infection prevention and control practices contribute to emergence of and encourage the further spread of MDR. Considering the significance of MDR, this paper, emphasizes the problems associated with MDR and the need to understand its significance and mechanisms to combat microbial infections.
    Interdisciplinary Perspectives on Infectious Diseases 07/2014; 2014(12):541340. DOI:10.1155/2014/541340
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    ABSTRACT: Rationale India reports the largest number of multidrug-resistant tuberculosis cases in the world; yet, no longitudinal study has assessed factors related to treatment outcomes under programmatic conditions in the public sector. Objectives To describe demographic, clinical and risk characteristics associated with treatment outcomes for all multidrug-resistant tuberculosis patients registered in the Revised National Tuberculosis Control Program, Kerala State, India during January 1, 2009 to June 30, 2010. Methods Cox regression methods were used to calculate adjusted hazard ratios with 95% confidence intervals to assess factors associated with unsuccessful treatment outcome. Measurements and Main Results Of 179 multidrug-resistant tuberculosis patients registered, 112 (63%) had successful treatment outcomes (77 bacteriologically cured, 35 treatment completed) and 67 (37%) had unsuccessful treatment outcomes (30 died, 26 defaulted, 9 failed treatment, 1 stopped treatment because of drug-related adverse events and 1 developed extensively drug resistant tuberculosis. The hazard for unsuccessful outcome was significantly higher among patients who consumed alcohol during treatment (adjusted hazard ratios: 4.3; 95% confidence intervals: 1.1-17.6) than those who did not. Persons who consumed alcohol during treatment, on average, missed 18 more intensive phase doses (95% confidence interval: 13-22) than those who did not. Although many patients were diabetic (33%), ever smokers (39%), or had low body mass index (47%) these factors were not associated with outcome. Conclusion Overall treatment success was greater than global and national averages; however, outcomes among patients consuming alcohol remained poor. Integration of care for multidrug-resistant tuberculosis and alcoholism should be considered to improve treatment adherence and outcomes.
    Annals of the American Thoracic Society 04/2014; 11(5). DOI:10.1513/AnnalsATS.201312-447OC
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