Abstract
Evidence on the cost and cost-effectiveness of treatment for multidrug-resistant tuberculosis (MDR-TB) is limited, and no published data are available from former Soviet Union countries where rates of MDR-TB are highest globally.
We evaluated the cost and cost-effectiveness of MDR-TB treatment in Estonia and the Russian Federation (Tomsk oblast), comparing cohorts enrolled on treatment according to World Health Organization (WHO) guidelines in 2001 and 2002 with cohorts treated in previous years. Costs were assessed from a health system perspective in year 2003 US$; effects were measured as cures, deaths averted and DALYs averted. Cure rates when WHO guidelines were followed were 61% (90/149) in Estonia and 76% (76/100) in Tomsk, with a cost per patient treated of US$ 8,974 and US$ 10,088 respectively. Before WHO guidelines were followed, cure rates were 52% in Estonia and 15% in Tomsk: the cost per patient treated was US$ 4,729 and US$ 2,282 respectively. Drugs and hospitalization accounted for 69–90% of total costs. The cost per DALY averted by treatment following WHO guidelines was US$ 579 (range 297–902) in Estonia and US$ 429 (range 302–546) in Tomsk.
Treatment of patients with MDR-TB can be cost-effective, but requires substantial additional investment in TB control in priority countries.
- ERS
