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Objectives The high cost of rifampicin-resistant tuberculosis ( RR- TB) treatment hinders treatment access. South Africa has a high RR- TB burden, and national policy outlines decentralisation to improve access and reduce costs. We analysed health system costs associated with RR- TB treatment by drug resistance profile and treatment outcome in a decentralised programme. Methods Retrospective, routinely collected patient-level data were combined with unit cost data to determine costs for each patient in a cohort treated between January 2009 and December 2011. Drug costs were based on recommended regimens according to drug resistance and treatment duration. Hospitalisation costs were estimated based on admission/discharge dates, while clinic visit and diagnostic/monitoring costs were estimated according to recommendations and treatment duration. Missing data were imputed. Results Among 467 patients (72% HIV infected), 49% were successfully treated. Treatment was initiated in primary care for 62%, with the remainder as inpatients. The mean cost per patient treated was $7916 (range 260-87 140), ranging from $5369 among patients who did not complete treatment to $23 006 for treatment failure. Mean cost for successful treatment was $8359 (2585-32 506). Second-line drug resistance was associated with a mean cost of $15 567 vs. $6852 for only first-line resistance, with the major cost difference due to hospitalisation. Costs are reported in 2013 USD. Conclusions RR- TB treatment cost was high and varied according to treatment outcome. Despite decentralisation, hospitalisation remained a significant cost, particularly among those with more extensive resistance and those with treatment failure. These cost estimates can be used to model the impact of new interventions to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background In South Africa, patients with multi-drug-resistant tuberculosis ( MDR- TB) are hospitalised from MDR- TB treatment initiation until culture conversion. Although MDR- TB accounts for <3% of incident TB in South Africa, 55% of the public sector TB budget is spent on MDR- TB. To inform new strategies for MDR- TB management, we estimated the per-patient cost ( USD 2011) of inpatient MDR- TB treatment. Methods All resources used by patients admitted to the MDR- TB hospital with confirmed MDR- TB from March 2009 to February 2010 were abstracted from patient records for up to 12 months after initial admission or until the earliest of final discharge, abscondment or death. Costs of hospital stay/day were estimated from hospital expenditure records and costs for drugs, laboratory tests, radiography and surgery from public sector sources. 133 patients met study inclusion criteria of whom 121 had complete cost records. Results By 12 months, 86% were discharged with culture conversion, 8% died in hospital, 2% were still admitted, and 3% had absconded. The mean hospital stay was 105 days. The mean total cost per patient was $17 164, of which 95% were hospitalisation costs (buildings, staff, etc.) and ≤ 2% each for MDR- TB drugs ($380); TB laboratory tests, including drug susceptibility testing ($236); and other costs. Conclusions The inpatient cost per patient treated for MDR- TB is more than 40 times the cost of treating drug-susceptible TB in South Africa. There is potential for substantial cost savings from improved management of drug-susceptible TB and shifting to a model of decentralised, outpatient MDR-treatment. [ABSTRACT FROM AUTHOR]