Health

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

Experts warn the U.S. could also see more cases of this difficult-to-treat strain of tuberculosis.

By Victoria Stagg Elliott — Posted Aug. 13, 2007

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

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.

Back to top


ADDITIONAL INFORMATION

Worldwide efforts at TB control

Countries hit hard by TB are boosting budgets, with a big share going to treatment of multidrug-resistant strains. The extensively resistant form is even more expensive to treat. A Centers for Disease Control and Prevention study found that nearly 10% of the MDR-TB isolates met criteria for XDR-TB.

Here's how spending breaks down in millions of dollars for the 22 countries with the greatest numbers of cases.

2002 2003 2004 2005 2006 2007
Total spent on tuberculosis control $509 $535 $771 $912 $1111 $1250
Directly observed therapy $272 $296 $510 $629 $758 $823
Novel approaches to detection and treatment $28 $28 $146 $153 $147 $117
Treating MDR-TB $28.8 $30.8 $90.6 $112 $117 $158
TB and HIV collaborative programs $5.2 $5.9 $17.9 $16.5 $31.0 $36.4
Operational research $0.19 $0.20 $0.24 $0.24 $12.5 $19.6
Other $1.21 $1.28 $1.48 $1.52 $45.53 $95.40
Unknown $173.10 $173.10 $3.76 $0 $0 $0

Note: Data not available from all countries for 2002-04

Source: "Global Tuberculosis Control: Surveillance, Planning, Financing," Emerging Infectious Diseases, March 19

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn