Cost of multidrug resistant tuberculosis in Germany—An update
Background: In 2019, new therapeutic recommendations for multidrug-resistant (MDR-) and extensively drug-resistant (XDR) tuberculosis (TB) were published by the WHO, advocating the use of oral drugs and stepwise composition of antibiotic regimens. To date, the economic consequences of those recommen...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-02-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971220322876 |
| _version_ | 1819059023027109888 |
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| author | R. Diel G. Sotgiu S. Andres D. Hillemann F.P. Maurer |
| author_facet | R. Diel G. Sotgiu S. Andres D. Hillemann F.P. Maurer |
| author_sort | R. Diel |
| collection | DOAJ |
| description | Background: In 2019, new therapeutic recommendations for multidrug-resistant (MDR-) and extensively drug-resistant (XDR) tuberculosis (TB) were published by the WHO, advocating the use of oral drugs and stepwise composition of antibiotic regimens. To date, the economic consequences of those recommendations in low incidence settings have not been evaluated. Objective: To assess the costs of applying the new recommendations against a set of 86 MDR-TB/XDR-TB strains, each with individual phenotypic drug resistance patterns, identified in 2018/2019 by the German National Reference Center for Mycobacteria. Methods: Hospitalization costs as covered by German statutory health insurance and the loss of productivity due to illness were calculated using the most recent 2018 statistical data. Costs due to combining five agents in the intensive phase and costs of outpatient monitoring were determined by Monte-Carlo simulation covering all treatment options over an 18-month period. Drug costs were compared to those arising under the approach recommended by the WHO in 2016. Results: Hospitalization costs per MDR-TB patient were €30,152 and the mean costs of antimicrobials over a period of 18 months were €66,854 (range €20,671 to €187,444). Total treatment costs, including outpatient monitoring, were €73,551.56 per patient (range €30,114 to €145.878). In addition, we determined an average cost of €11,410.20 due to productivity loss over a period of 6 months sick leave. Despite a shortened minimum recommended treatment duration (18 versus 20 months), the estimated costs were 24.5% higher based on the 2019 recommendations as compared to the 2016 guideline version. Conclusion: Higher costs for treating MDR-TB/XDR-TB in Germany are to be expected under the new WHO regimens. However, it must be determined whether treatment duration and costs associated with sick leave may be further reduced in the future through shorter hospital stays and earlier culture conversion. |
| first_indexed | 2024-12-21T14:04:30Z |
| format | Article |
| id | doaj.art-5669b5df9f074bd4953a4c1644455fe2 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-21T14:04:30Z |
| publishDate | 2021-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-5669b5df9f074bd4953a4c1644455fe22022-12-21T19:01:16ZengElsevierInternational Journal of Infectious Diseases1201-97122021-02-01103102109Cost of multidrug resistant tuberculosis in Germany—An updateR. Diel0G. Sotgiu1S. Andres2D. Hillemann3F.P. Maurer4Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany; Lung Clinic Grosshansdorf, Großhansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany; Corresponding author at: Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Niemannsweg 11, 24015 Kiel, Germany.University of Sassari, Sassari, ItalyNational and WHO Supranational Reference Center for Mycobacteria, Research Center Borstel, Borstel, GermanyNational and WHO Supranational Reference Center for Mycobacteria, Research Center Borstel, Borstel, GermanyNational and WHO Supranational Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany; Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyBackground: In 2019, new therapeutic recommendations for multidrug-resistant (MDR-) and extensively drug-resistant (XDR) tuberculosis (TB) were published by the WHO, advocating the use of oral drugs and stepwise composition of antibiotic regimens. To date, the economic consequences of those recommendations in low incidence settings have not been evaluated. Objective: To assess the costs of applying the new recommendations against a set of 86 MDR-TB/XDR-TB strains, each with individual phenotypic drug resistance patterns, identified in 2018/2019 by the German National Reference Center for Mycobacteria. Methods: Hospitalization costs as covered by German statutory health insurance and the loss of productivity due to illness were calculated using the most recent 2018 statistical data. Costs due to combining five agents in the intensive phase and costs of outpatient monitoring were determined by Monte-Carlo simulation covering all treatment options over an 18-month period. Drug costs were compared to those arising under the approach recommended by the WHO in 2016. Results: Hospitalization costs per MDR-TB patient were €30,152 and the mean costs of antimicrobials over a period of 18 months were €66,854 (range €20,671 to €187,444). Total treatment costs, including outpatient monitoring, were €73,551.56 per patient (range €30,114 to €145.878). In addition, we determined an average cost of €11,410.20 due to productivity loss over a period of 6 months sick leave. Despite a shortened minimum recommended treatment duration (18 versus 20 months), the estimated costs were 24.5% higher based on the 2019 recommendations as compared to the 2016 guideline version. Conclusion: Higher costs for treating MDR-TB/XDR-TB in Germany are to be expected under the new WHO regimens. However, it must be determined whether treatment duration and costs associated with sick leave may be further reduced in the future through shorter hospital stays and earlier culture conversion.http://www.sciencedirect.com/science/article/pii/S1201971220322876Cost analysisMonte Carlo simulationTuberculosisMDR-TBXDR-TBAntimicrobial resistance |
| spellingShingle | R. Diel G. Sotgiu S. Andres D. Hillemann F.P. Maurer Cost of multidrug resistant tuberculosis in Germany—An update International Journal of Infectious Diseases Cost analysis Monte Carlo simulation Tuberculosis MDR-TB XDR-TB Antimicrobial resistance |
| title | Cost of multidrug resistant tuberculosis in Germany—An update |
| title_full | Cost of multidrug resistant tuberculosis in Germany—An update |
| title_fullStr | Cost of multidrug resistant tuberculosis in Germany—An update |
| title_full_unstemmed | Cost of multidrug resistant tuberculosis in Germany—An update |
| title_short | Cost of multidrug resistant tuberculosis in Germany—An update |
| title_sort | cost of multidrug resistant tuberculosis in germany an update |
| topic | Cost analysis Monte Carlo simulation Tuberculosis MDR-TB XDR-TB Antimicrobial resistance |
| url | http://www.sciencedirect.com/science/article/pii/S1201971220322876 |
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