Multidrug-resistant tuberculosis (MDR-TB) and treatment costs in tuberculosis-clinic, Maharaj Nakhon Ratchasima Hospital, 2013-2015

  • Kanjana Changkaew Thammasat University
  • Piyaporn Monchartree Office of Disease Prevention and Control 9, Nakhon Ratchasima
Keywords: tuberculosis (TB), multidrug-resistant tuberculosis (MDR-TB), treatment cost

Abstract

This study aimed to assess the characteristics and proportion of MDR-TB patients among high-risk populations relevant to the National Tuberculosis Program (NTP) guidelines in prioritizing patients at risk of developing MDR-TB and treatment costs of multidrug-resistant tuberculosis (MDR-TB) patients in TB clinic of Maharaj Nakhon Ratchasima Hospital during the fiscal years 2013-2015. Data were collected retrospectively from the TB register (TB03) and National Tuberculosis Information Program (NTIP). Ten cases of MDR-TB who were on treatment were interviewed. Of 1,032 tuberculosis patients, 42 (4.1%) patients were diagnosed with MDR-TB. The results showed an increasing trend of MDR-TB. In this particular region, MDR-TB was observed in re-treatment patients at the highest rate (71.4%). Almost all MDR-TB patients (90.5%) had a history of exposure to first-line anti-tuberculosis drugs before receiving second-line anti-TB drug regimens and 9.5% of the MDR-TB patients who had drug resistance positive results confirmed by line probe assay were immediately treated with second-line anti-tuberculosis drugs. The average cost of first-line and second-line anti-tuberculosis medications was 1,181.1 and 99,021.9 Baht, respectively, while the average cost of the laboratory test was 2,809 Baht. This has brought a total treatment cost (medications and laboratory tests) for MDR-TB patients to 103,011.9 Baht. Additionally, costs other than medications and laboratory tests were calculated from travel and meal expenses, which were the two expenses to focus on. The average travel and meal expenses during any given hospital visit were 844 and 255 baht/person/time, respectively. In conclusion, this study highlighted the importance of systematic early screening for MDR-TB in high-risk groups, particularly among re-treatment patients. The TB preventive measure for MDR-TB should be strengthened in line with the National Tuberculosis Control Guidelines. Furthermore, the knowledge gained from this study could be utilized to inform more effective management of TB cases in Nakhon Ratchasima province and other areas.

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References

World Health Organization. Global tuberculosis report 2018. Geneva: World Health Organization; 2019.

Bureau of Tuberculosis, Department of Disease Control. Thailand operational plan to end tuberculosis 2017-2021. Nonthaburi: Bureau of Tuberculosis, Department of Disease Control; 2017. (in Thai)

Bureau of Tuberculosis, Department of Disease Control. Thailand operational plan to end tuberculosis, fiscal year 2019 [Internet]. Nonthaburi: Bureau of Tuberculosis, Department of Disease Control; 2019 [cited 2019 Oct 28]. 90 p. Available from: https://www.tbthailand.org/download/Manual/คู่มือ%20PA%20และแนวทางการตรวจราชการ%20edit%20March%205%202019.pdf (in Thai)

Bureau of Tuberculosis, Department of Disease Control. Thailand guidelines for the prevention and control of extensively drug-resistant tuberculosis (XDR-TB). Nonthaburi: Bureau of Tuberculosis, Department of Disease Control; 2019. (in Thai)

Deivanayagam CN, Rajasekaran S, Venkatesan R, Mahilmaran A, Ahmed PR, Annadurai S, et al. Prevention of acquired MDR-TB and HIV coinfection. Indian J Chest Dis Allied Sci 2002;44:237-42.

Bureau of Tuberculosis, Department of Disease Control. Guideline for programmatic management of drug-resistant tuberculosis. Nonthaburi: Bureau of Tuberculosis, Department of Disease Control; 2015. (in Thai)

Srithongtham O, Jongtrakansombat A, Thabuddha U, Uttha S, Palanan C. Factors related to default and failure treatment of multidrug-resistant TB patients in the provinces under the responsibility of the Office of Disease Prevention and Control Region 7, Ubon Ratchathani. J Health Science 2017;26:S289-98. (in Thai)

Bureau of Epidemiology, Department of Disease Control. Forecasting of multidrug-resistant tuberculosis by using risk analysis, 2013 [Internet]. 2013 [cited 2019 Nov 4]. Available from: http://www.interfetpthailand.net/forecast/index.php?m=home &n=report2012_11 (in Thai)

Tatiyanantaporn S, Nasungnoen B. A comparative study on duration from MDR-TB diagnosis to treatment initiation using three difference xpert mtb/rif, line probe assay and phenotypic dst: a case study from Nakhon Ratchasima province 1st October 2012 - 31st March 2017. The Office of Disease Prevention and Control 9th Nakhon Ratchasima Journal 2018;24:34-42. (in Thai)

Ministry of Public Health. E-Inspection 2019 [Internet]. 2019 [cited 2019 Aug 12]. Available from: http://bie.moph.go.th/e-insreport/index.php (in Thai)

Maokamnerd Y, Khamphira S, Kavinum S, Iemrod K, Swaddiwudhipong W. Situation of multidrug-resistant tuberculosis in Tak Province, Fiscal Year 2011 – April 2014. Thai journal of tuberculosis chest diseases and critical care 2014;35:8-17. (in Thai)

Pinyochotiwong C. Prevalence and risk factors of multidrug-resistant tuberculosis patients in Charoenkrung Pracharak Hospital. Journal of Charoenkrung Pracharak Hospital 2018;14:1-10. (in Thai)

Liu Q, Zhu L, Shao Y, Song H, Li G, Zhou Y, et al. Rates and risk factors for drug resistance tuberculosis in Northeastern China. BMC Public Health 2013;13:1171.

Jitmuang A, Munjit P, Foongladda S. Prevalence and factors associated with multidrug-resistant tuberculosis at Siriraj Hospital, Bangkok, Thailand. Southeast Asian J Trop Med Public Health 2015;46:697-706.

Luzze H, Johnson DF, Dickman K, Mayanja-Kizza H, Okwera A, Eisenach K, et al. Relapse more common than reinfection in recurrent tuberculosis 1-2 years post treatment in urban Uganda. Int J Tuberc Lung Dis 2013;17:361-7.

Kamolwat A, Phanrod N. Multi-drug resistant tuberculosis (MDR-TB) and short course regimen treatment outcome at Maharaj Nakhon Ratchasima Hospital. Dis Control J 2008;34:204-14. (in Thai)

Boonsarngsuk V, Tansirichaiya K, Kiatboonsri S. Thai drug-resistant tuberculosis predictive scores. Singapore Med J 2009;50:378-84.

Caminero JA. Management of multidrug-resistant tuberculosis and patients in retreatment. Eur Respir J 2005;25:928-36.

Bureau of Tuberculosis, Department of Disease Control. National tuberculosis control programme guideline, Thailand 2018. Nonthaburi: Bureau of Tuberculosis, Department of Disease Control; 2018. (in Thai)

Diel R, Vandeputte J, de Vries G, Stillo J, Wanlin M, Nienhaus A. Costs of tuberculosis disease in the European Union: a systematic analysis and cost calculation. Eur Respir J 2014;43:554-65.

Laurence YV, Griffiths UK, Vassall A. Costs to health services and the patient of treating tuberculosis: a systematic literature review. Pharmacoeconomics 2015;33:939-55.

Pooran 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;8:e54587.

Published
2020-05-22
Section
Original Article