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