XDR-TB straining world's health budgets; emphasis turning to containment

With a mere handful of cases of extensively drug-resistant tuberculosis in the U.S. -- but many more elsewhere in the world -- those working to control the illness warn that it could become more common here and weigh heavily on the domestic health care system.

"TB is no respecter of national borders, or ethnic and racial boundaries," said Michael E. Fleenor, MD, MPH, chair of the Advisory Council for the Elimination of Tuberculosis at the Centers for Disease Control and Prevention and health officer for the Jefferson County Dept. of Health in Birmingham, Ala. "We're running out of bullets to shoot at this organism."

A growing share of tuberculosis-control budgets in the hardest hit countries is expended on caring for multidrug-resistant tuberculosis. Studies have found that some of the cases deemed MDR-TB are actually XDR-TB, and thus are even harder and more expensive to treat. This reality is not lost on those fighting TB in the U.S. Treatment of one case of TB costs $6,000 in Alabama, Dr. Fleenor said. MDR-TB takes the expense to $30,000, and XDR-TB raises the cost to $500,000.

"It's a burden already, even though there are only a small number of cases," said Peter Cegielski, MD, the CDC's team leader for drug-resistant tuberculosis.

XDR-TB is so difficult and expensive to treat because physicians have to struggle to find effective antibiotics. Even with surgical excision of infected tissue, antibiotics are still needed for residual bacteria.

In order to address this burgeoning problem, the World Health Organization and the Stop TB Partnership in June announced an international containment plan. The same month, the American Medical Association, at its Annual Meeting, adopted policy in support of federal legislation to increase resources for global and domestic TB control.