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Gu P, Lu P, Ding H, Liu Q, Ding X, Chen Y, Zhu L. Effectiveness, cost, and safety of four regimens recommended by WHO for RR/MDR-TB treatment: a cohort study in Eastern China. Ann Med 2024; 56:2344821. [PMID: 38697138 PMCID: PMC11067554 DOI: 10.1080/07853890.2024.2344821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/24/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND To compare the effectiveness, cost, and safety of four regimens recommended by the World Health Organization (WHO) for rifampicin resistance/multidrug-resistance tuberculosis (RR/MDR-TB) Treatment in Eastern China. METHODS We performed a cohort study among patients with RR/MDR between 2020 and 2022 in Jiangsu Province. The treatment success rate, cost, and drug adverse reaction rate were compared. RESULTS Between 2020 and 2022, 253 RR/MDR-TB patients were enrolled in the study. 37 (14.62%), 76 (30.04%), 74 (29.25%), and 66 (26.09%) patients had the short-term regimens, the new long-term oral regimens, the new long-term injectable regimens, and the traditional long-term regimens, respectively. The treatment success rate was the highest among patients treated with the short-term regimen (75.68%) and was the lowest among patients treated with the traditional long-term regimens (60.61%). The estimated mean cost per favorable outcome was 142.61 thousand Chinese Yuan (CNY), and the short-term regimens showed the lowest cost in the four regimes (88.51 thousand CNY vs. 174.24 thousand CNY, 144.00 thousand CNY, and 134.98 thousand CNY). Incremental cost-effectiveness ratios of the short-term regimens, the new long-term oral regimen, and the new long-term injectable regimens were -3083.04, 6040.09, and 819.68 CNY compared to the traditional long-term regimens. CONCLUSIONS For RR/MDR-TB patients in China who meet the criteria for short-term regimens, the short-term regimens were proven to be the most cost-effective of the four regimens recommended by WHO. For RR/MDR-TB patients in China who don't meet the criteria for short-term regimens, the new long-term injectable regimens are more cost-effective than the remaining two regimens.
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Affiliation(s)
- Pengcheng Gu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Hui Ding
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Xiaoyan Ding
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Yongfa Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
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Zhou M, Peng Y, Liu K, Zhou L, Wang F, Chen X, Chen B, Hu C. Direct Medical Expenses and Influencing Factors of MDR/RR-TB in Eastern China: Based on Data from Multi-Hospital Information Systems. Risk Manag Healthc Policy 2023; 16:1955-1965. [PMID: 37753096 PMCID: PMC10518261 DOI: 10.2147/rmhp.s420082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/02/2023] [Indexed: 09/28/2023] Open
Abstract
Background Multidrug-resistant (MDR) and rifampicin-resistant (RR) tuberculosis (TB) is related to high healthcare costs. However, studies on direct healthcare expenditure in different settings remain inconclusive. Hence, we aimed to examine the direct medical expenses (DME) of patients with MDR/RR-TB and assessed which patient characteristics were associated with higher costs. Methods DME was evaluated using records from the hospital information system in three cities with different economic levels in Zhejiang Province, Eastern China, matching with data (including socio-demographics, disease treatment status, etc.) collected in the Tuberculosis Management Information System. A logistic regression model was used to identify variables associated with higher costs. Results Of 193 patients with MDR/RR-TB, the average DME was $10,491 (interquartile range (IQR) $4679-16,710), consisting of $2696 (IQR $1019-5100) out-of-pocket costs, medical reimbursement, and subsidies, accounting for 32%, 50.3% and 14%, respectively. A total of 74.2% and 56% of DME were for drugs and anti-TB drugs, respectively. Only 16.9% of the patients were treated with an all-oral regimen. Higher DME was significantly associated with local residents 7.29 (95% confidence interval (CI) [2.62-20.3]), hospitalization experience 7.63 (95% (CI) [2.54-22.95]), longer duration of treatment 6.63 (95% CI [2.27-19.35]), and lower health insurance reimbursement 5.65 (95% CI [1.90-16.79]). Conclusion DME of patients with MDR/RR-TB was still significant, and domestic migrants, hospitalization, long treatment duration, and high health insurance rates increased the financial burden on MDR/RR-TB patients. Reasonable intervention programs should be developed to reduce the medical burden of patients with MDR/RR-TB, according to the DME and its component of MDR-TB patients, besides the economic status of their regions.
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Affiliation(s)
- Meng Zhou
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Ying Peng
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Lin Zhou
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Fei Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Xinyi Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Bin Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Chonggao Hu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
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O'Connell J, McNally C, Stanistreet D, de Barra E, McConkey SJ. Ending tuberculosis: the cost of missing the World Health Organization target in a low-incidence country. Ir J Med Sci 2023; 192:1547-1553. [PMID: 36121600 PMCID: PMC9483873 DOI: 10.1007/s11845-022-03150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ending tuberculosis (TB) is a global priority and targets for doing so are outlined in the World Health Organization (WHO) End TB Strategy. For low-incidence countries, eliminating TB requires high levels of wealth, low levels of income inequality and effective TB programmes and services that can meet the needs of people who have not benefited from these and are still at risk of TB. In Ireland, numerous reports have noted a need for more funding for TB prevention and control. AIM The aim of this research was to estimate the cost of not meeting the WHO End TB target of a 90% reduction in TB incidence in Ireland between 2015 and 2035. METHODS The cost of projected TB cases between 2022 and 2035 is estimated based on trends in surveillance data for the period 2015 to 2019 and outcomes reported in the literature. RESULTS Between 2022 and 2035, it is projected that a failure to meet the WHO End TB Strategy target will result in an additional 989 cases of TB, 577.3 disability-adjusted life years and 35 deaths with TB in Ireland. The cost of this is estimated to be €70.779 million. CONCLUSION Given the estimated cost, Ireland's current prospects of eliminating TB and the tendency towards programmatic funding internationally, greater investment in TB prevention and control in Ireland is justifiable. A national elimination strategy with actions at the levels of the social determinants of health, the health system and the TB programme should be funded.
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Affiliation(s)
- James O'Connell
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Cora McNally
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland
| | - Debbi Stanistreet
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan de Barra
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland
| | - Samuel J McConkey
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland
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O’Connell J, Reidy N, McNally C, de Barra E, Stanistreet D, McConkey S. Delayed Tuberculosis Treatment and Cost of Care in a Low-Incidence Country. Open Forum Infect Dis 2022; 9:ofac164. [PMID: 35611347 PMCID: PMC9124588 DOI: 10.1093/ofid/ofac164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background Tuberculosis (TB) elimination requires high-quality, timely care. In countries with a low incidence of TB, such as Ireland, delayed diagnosis is common. This evaluation aimed to determine the factors that predict patient-related and health care provider–related delays in TB management and to establish how TB care cost is affected by care delays. Methods Health care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1, 2018, and December 31, 2019, were reviewed to measure and determine predictors of patient-related delays, health care provider–related delays, and the cost of TB care. Outcomes were compared against benchmarks derived from the literature. Results Thirty-seven patients were diagnosed with TB, and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider–related delay among patients with PTB was 16 days and, although similar to the benchmark (median, 22 days; minimum, 11 days; maximum, 36 days), could be improved. The health care provider–related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298 and, while similar to that reported in the literature (median, €9319; minimum, €6486; maximum, €14 750), could be improved. Patient-related delays among those with PTB predicted care costs. Conclusions Patient-related and health care provider–related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.
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Affiliation(s)
- James O’Connell
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Dublin, Ireland
| | - Niamh Reidy
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Dublin, Ireland
| | - Cora McNally
- Beaumont Hospital, Health Service Executive, Beaumont, Dublin 9, Ireland
| | - Eoghan de Barra
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Dublin, Ireland
- Beaumont Hospital, Health Service Executive, Beaumont, Dublin 9, Ireland
| | - Debbi Stanistreet
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Dublin, Ireland
| | - Samuel McConkey
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Dublin, Ireland
- Beaumont Hospital, Health Service Executive, Beaumont, Dublin 9, Ireland
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