Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013;8(1):e54587.
doi: 10.1371/journal.pone.0054587. Epub 2013 Jan 18.

What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa?

Anil Pooran  1 , Elize Pieterson, Malika Davids, Grant Theron, Keertan Dheda
Affiliations

What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa?

Anil Pooran et al. PLoS One. 2013.

Abstract

Background: Drug-resistant tuberculosis (DR-TB) is undermining TB control in South Africa. However, there are hardly any data about the cost of treating DR-TB in high burden settings despite such information being quintessential for the rational planning and allocation of resources by policy-makers, and to inform future cost-effectiveness analyses.

Methodology: We analysed the comparative 2011 United States dollar ($) cost of diagnosis and treatment of drug sensitive TB (DS-TB), MDR-TB and XDR-TB, based on National South African TB guidelines, from the perspective of the National TB Program using published clinical outcome data.

Principal findings: Assuming adherence to national DR-TB management guidelines, the per patient cost of XDR-TB was $26,392, four times greater than MDR-TB ($6772), and 103 times greater than drug-sensitive TB ($257). Despite DR-TB comprising only 2.2% of the case burden, it consumed ~32% of the total estimated 2011 national TB budget of US $218 million. 45% and 25% of the DR-TB costs were attributed to anti-TB drugs and hospitalization, respectively. XDR-TB consumed 28% of the total DR-TB diagnosis and treatment costs. Laboratory testing and anti-TB drugs comprised the majority (71%) of MDR-TB costs while hospitalization and anti-TB drug costs comprised the majority (92%) of XDR-TB costs. A decentralized XDR-TB treatment programme could potentially reduce costs by $6930 (26%) per case and reduce the total amount spent on DR-TB by ~7%.

Conclusion/significance: Although DR-TB forms a very small proportion of the total case burden it consumes a disproportionate and substantial amount of South Africa's total annual TB budget. These data inform rational resource allocation and selection of management strategies for DR-TB in high burden settings.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: KD is a PLOS ONE Editorial Board member. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. The cost breakdown of the total cost per patient for drug sensitive (DS-TB), multi-drug resistant (MDR-TB) and extensively drug-resistant (XDR-TB) tuberculosis.
*Other indicates surgery, ADRs and death related costs.
Figure 2
Figure 2. The total number, national costs and cost breakdown of notified cases of drug sensitive (DS-TB), multi-drug resistant (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) reported in 2010.
Costs are expressed in $US and refer to the cost of diagnosis and treatment of confirmed cases. *Other indicates surgery, ADRs and death related costs.
Figure 3
Figure 3. The total drugs costs of notified cases of drug sensitive (DS-TB), multi-drug resistant (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) reported in 2010.
Costs are expressed in $US.
See this image and copyright information in PMC

References

    1. World Health Organization (2011) WHO Report 2011: Global Tuberculosis Control. (2011) Available: http://www.who.int/tb/publications/global_report/en/. Accessed 2012 Oct 20.
    1. United Nations (2011) The UN Millenium Development Goals Report 2011 (2011) Available: www.un.org/millenniumgoals/reports.shtml.Accessed 2012 Mar.
    1. Dheda K, Migliori GB (2012) The global rise of extensively drug-resistant tuberculosis: is the time to bring back sanatoria now overdue? Lancet 379: 773–775. - PubMed
    1. Dheda K, Warren RM, Zumla A, Grobusch MP (2010) Extensively drug-resistant tuberculosis: epidemiology and management challenges. Infect Dis Clin North Am 24: 705–725. - PubMed
    1. South African Department of Health (2011) Management of Drug-Resistant Tuberculosis: Policy Guidelines (2011) Available: www.kznhealth.gov.za/pharmacy/ptc/MDR2011.pdf.Accessed 2012 Oct 3.

Publication types

MeSH terms

Substances

LinkOut - more resources