The costs of MDR/XDR tuberculosis in Barcelona (Spain): Cases treated with DOTs/DOT plus in a specialized centre

Objectives: To evaluate the direct costs of TB cases treated with DOTS/DOTS-plus in a specialized centre in Barcelona, Spain. Methods: A cross sectional study of TB cases treated in a specialized centre as in-patient or in-patient/out-patient after bacteriological negativization from 2000 to 2012, most of them have factors associated to poor adherence. Treatment was done following ERS and SEPAR Guidelines. Direct costs (in euros ,€) included: laboratory-radiological work, medical TB treatment, in-patient centre and out-patient visits during the 2 years9 of treatment. Results: Among 1401 TB cases, 1261 were TB sensitive, 63 (4.5%) mono-poliresistant, 71 (5.1%) MDR-TB and 6 (0.43%) were XDR-TB. Between MDR/XDR-TB cases 67.5% were immigrants. Direct costs of TB cases were estimated for a total in-patient during treatment and for a half in-patient/half-outpatient treatment. Drugs cost 215€ in TB sensitive cases, 2118 in TB-MDR, 15441 in TB-MDR plus other resistances and 40808 in TB-XDR. The 86.1% of MDR/XDR-TB cases were cured and 7.6% died. In drug sensitive the total cost as in-patient were 15001€, in TB-MDR patient was 60306€, in TB-MDR plus other resistances was 73599€ and in TB-XDR total cost was 98996€. When patients go home after sputum culture negativization the cost lowers 30%. HIV coinfection increases the cost 20%. Conclusion: To cure MDR/XDR-TB have a high economical impact not only by the TB drugs9 cost but also by DOT. But the high rate of MDR/XDR-TB cases cured allows to improve their lifetime, to avoid the death risk and the transmission of resistant baccills into the community.