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

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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.

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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

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