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Culture conversion, treatment completion rates high in MDR TB
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In the United States, patients with multidrug-resistant and extensively drug-resistant tuberculosis appear to have high rates of culture conversion and treatment completion, as well as low mortality rates, according to recent study findings.
However, the positive treatment outcomes came at a significant cost to the private sector, researchers said.
In the study, researchers identified cases of MDR and XDR TB reported to the CDC between 2005 and 2007 from California, New York City and Texas — three geographical areas that contribute approximately half of MDR TB cases reported each year in the United States.
The researchers analyzed hospital, laboratory and public health clinic records for information on patient demographics, socioeconomic status and clinical traits. They also collected and assessed information about treatment, case management, expense and clinical outcomes. Hospital UB-04 forms were used to collect information on the total charges for each TB-related hospitalization. The investigators determined sputum-culture conversion and drug resistance by reviewing all accessible culture and susceptibility results for the duration of each case.
The sample consisted of 135 patients, 130 of whom had MDR TB and five who had XDR TB. The sample represented 36% of MDR TB cases and 56% of XDR TB cases reported in the United States between 2005 and 2007.
Among patients for whom data on comorbidities was accessible, 20% of 121 had diabetes and 12% of 116 had HIV.
Of 112 patients eligible for culture conversion, the rate of conversion was 97%. Culture conversion took place within a median of 2 months after initiating a five-drug treatment regimen. Of the 134 patients who were alive at diagnosis, 78% completed treatment, 11% transferred within or outside the United States or were lost to follow-up, and 1% discontinued the treatment regimen due to adverse events.
There was no treatment failure or TB recurrence within 1 year after the end of treatment. Twelve (9%) of the 134 patients died during treatment, and 75% of these deaths were related to TB.
Direct costs averaged $134,000 per MDR TB patient and $430,000 per XDR TB patient — most of which was covered by the private sector, according to the researchers. In contrast, the estimated cost for each non-MDR TB patient totaled $17,000.
“Despite the extensive drug resistance found at the time of diagnosis, culture conversion and treatment completion rates were high and mortality rates were low,” the researchers wrote. “Records of treatment practices documented near-universal use of directly observed therapy. However, these outcomes came at a high cost to the public sector, providing incentives for the United States to prevent MDR/XDR TB.”
Disclosure: The researchers report no relevant financial disclosures.
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