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

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dc.contributor.authorPooran, Anilen_ZA
dc.contributor.authorPieterson, Elizeen_ZA
dc.contributor.authorDavids, Malikaen_ZA
dc.contributor.authorTheron, Granten_ZA
dc.contributor.authorDheda, Keertanen_ZA
dc.date.accessioned2016-01-11T06:51:34Z
dc.date.available2016-01-11T06:51:34Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: 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 $6930 (26%) per case and reduce the total amount spent on DR-TB by ∼7%. Conclusion/Significance Although DR-TB forms a very small proportion of the total case burden it consumes a disproportionate and substantial amount of South Africa's total annual TB budget. These data inform rational resource allocation and selection of management strategies for DR-TB in high burden settings.en_ZA
dc.identifier.apacitationPooran, A., Pieterson, E., Davids, M., Theron, G., & Dheda, K. (2013). What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/16246en_ZA
dc.identifier.chicagocitationPooran, Anil, Elize Pieterson, Malika Davids, Grant Theron, and Keertan Dheda "What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/16246en_ZA
dc.identifier.citationPooran, A., Pieterson, E., Davids, M., Theron, G., & Dheda, K. (2013). What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa. PLoS One, 8(1), e54587. doi:10.1371/journal.pone.0054587en_ZA
dc.identifier.ris TY - Journal Article AU - Pooran, Anil AU - Pieterson, Elize AU - Davids, Malika AU - Theron, Grant AU - Dheda, Keertan AB - BACKGROUND: Drug-resistant tuberculosis (DR-TB) is undermining TB control in South Africa. However, there are hardly any data about the cost of treating DR-TB in high burden settings despite such information being quintessential for the rational planning and allocation of resources by policy-makers, and to inform future cost-effectiveness analyses. METHODOLOGY: We analysed the comparative 2011 United States dollar ($) 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. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0054587 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa TI - What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa UR - http://hdl.handle.net/11427/16246 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16246
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0054587
dc.identifier.vancouvercitationPooran A, Pieterson E, Davids M, Theron G, Dheda K. What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa. PLoS One. 2013; http://hdl.handle.net/11427/16246.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Pulmonologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Pooran et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherExtensively drug-resistant tuberculosisen_ZA
dc.subject.otherMulti-drug-resistant tuberculosisen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherOutpatientsen_ZA
dc.subject.otherDrug therapyen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherTuberculosis diagnosis and managementen_ZA
dc.subject.otherInpatientsen_ZA
dc.titleWhat is the cost of diagnosis and management of drug resistant tuberculosis in South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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