Treatment practices, outcomes, and costs of multidrug-resistant and extensively drug-resistant tuberculosis, United States, 2005-2007

Emerg Infect Dis. 2014 May;20(5):812-21. doi: 10.3201/eid2005.131037.

Abstract

To describe factors associated with multidrug-resistant (MDR), including extensively-drug-resistant (XDR), tuberculosis (TB) in the United States, we abstracted inpatient, laboratory, and public health clinic records of a sample of MDR TB patients reported to the Centers for Disease Control and Prevention from California, New York City, and Texas during 2005-2007. At initial diagnosis, MDR TB was detected in 94% of 130 MDR TB patients and XDR TB in 80% of 5 XDR TB patients. Mutually exclusive resistance was 4% XDR, 17% pre-XDR, 24% total first-line resistance, 43% isoniazid/rifampin/rifabutin-plus-other resistance, and 13% isoniazid/rifampin/rifabutin-only resistance. Nearly three-quarters of patients were hospitalized, 78% completed treatment, and 9% died during treatment. Direct costs, mostly covered by the public sector, averaged $134,000 per MDR TB and $430,000 per XDR TB patient; in comparison, estimated cost per non-MDR TB patient is $17,000. Drug resistance was extensive, care was complex, treatment completion rates were high, and treatment was expensive.

Keywords: TB; Tuberculosis; United States; cost; drug resistance; extensively drug-resistant tuberculosis; multidrug-resistant tuberculosis; outcomes; treatment practices; tuberculosis and other mycobacteria.

Publication types

  • Historical Article
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antitubercular Agents / pharmacology
  • Antitubercular Agents / therapeutic use
  • Comorbidity
  • Drug Therapy, Combination
  • Extensively Drug-Resistant Tuberculosis / drug therapy
  • Extensively Drug-Resistant Tuberculosis / epidemiology*
  • Extensively Drug-Resistant Tuberculosis / history
  • Female
  • Health Care Costs*
  • History, 21st Century
  • Humans
  • Male
  • Mycobacterium tuberculosis / drug effects
  • Mycobacterium tuberculosis / genetics
  • Outcome Assessment, Health Care
  • Risk Factors
  • Treatment Outcome
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Tuberculosis, Multidrug-Resistant / epidemiology*
  • Tuberculosis, Multidrug-Resistant / history
  • United States / epidemiology

Substances

  • Antitubercular Agents