{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T23:12:00Z","timestamp":1771369920959,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2015,6,1]],"date-time":"2015-06-01T00:00:00Z","timestamp":1433116800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["099818\/Z\/12\/Z"],"award-info":[{"award-number":["099818\/Z\/12\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The high cost of rifampicin\u2010resistant tuberculosis (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content>) treatment hinders treatment access. South Africa has a high <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> burden, and national policy outlines decentralisation to improve access and reduce costs. We analysed health system costs associated with <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> treatment by drug resistance profile and treatment outcome in a decentralised programme.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective, routinely collected patient\u2010level data were combined with unit cost data to determine costs for each patient in a cohort treated between January 2009 and December 2011. Drug costs were based on recommended regimens according to drug resistance and treatment duration. Hospitalisation costs were estimated based on admission\/discharge dates, while clinic visit and diagnostic\/monitoring costs were estimated according to recommendations and treatment duration. Missing data were imputed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 467 patients (72% <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> infected), 49% were successfully treated. Treatment was initiated in primary care for 62%, with the remainder as inpatients. The mean cost per patient treated was $7916 (range 260\u201387\u00a0140), ranging from $5369 among patients who did not complete treatment to $23\u00a0006 for treatment failure. Mean cost for successful treatment was $8359 (2585\u201332\u00a0506). Second\u2010line drug resistance was associated with a mean cost of $15\u00a0567 <jats:italic>vs<\/jats:italic>. $6852 for only first\u2010line resistance, with the major cost difference due to hospitalisation. Costs are reported in 2013 USD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> treatment cost was high and varied according to treatment outcome. Despite decentralisation, hospitalisation remained a significant cost, particularly among those with more extensive resistance and those with treatment failure. These cost estimates can be used to model the impact of new interventions to improve patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12544","type":"journal-article","created":{"date-parts":[[2015,5,15]],"date-time":"2015-05-15T11:35:31Z","timestamp":1431689731000},"page":"1337-1345","source":"Crossref","is-referenced-by-count":32,"title":["Cost per patient of treatment for rifampicin\u2010resistant tuberculosis in a community\u2010based programme in Khayelitsha, South Africa"],"prefix":"10.1111","volume":"20","author":[{"given":"Helen","family":"Cox","sequence":"first","affiliation":[{"name":"Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine University of Cape Town Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lebogang","family":"Ramma","sequence":"additional","affiliation":[{"name":"Health Economics Unit University of Cape Town Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynne","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res (MSF) Khayelitsha South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginia","family":"Azevedo","sequence":"additional","affiliation":[{"name":"City of Cape Town Health Department Khayelitsha South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edina","family":"Sinanovic","sequence":"additional","affiliation":[{"name":"Health Economics Unit University of Cape Town Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,6]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"World Health Organization.Global Tuberculosis Report 2014.World Health Organization Geneva 2014. Contract No.: WHO\/HTM\/TB\/2014.08."},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.2165\/11595340-000000000-00000"},{"key":"e_1_2_5_4_1","volume-title":"Guidelines for the Programmatic Management of Drug\u2010resistant Tuberculosis: 2011 Update","author":"World Health Organization","year":"2011"},{"key":"e_1_2_5_5_1","first-page":"978","article-title":"Decentralised management of drug\u2010resistant tuberculosis (MDR\u2010 and XDR\u2010TB) in South Africa: an alternative model of care","volume":"12","author":"Padayatchi N","year":"2008","journal-title":"Int J Tuberc Lung Dis"},{"key":"e_1_2_5_6_1","unstructured":"National Health Laboratory Service.GeneXpert MTB\/RIF Progress Report July 2014.2014."},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12018"},{"key":"e_1_2_5_8_1","unstructured":"National Department of Health South Africa.Management of drug\u2010resistant tuberculosis: policy guidelines. Department of Health South Africa 2011."},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0054587"},{"key":"e_1_2_5_10_1","volume-title":"City of Cape Town \u2013 2011 Census Suburb Khayelitsha","author":"Strategic Development Information and GIS Department (SDI&GIS)","year":"2013"},{"key":"e_1_2_5_11_1","unstructured":"Western Cape Department of Health.Western Cape antenatal HIV survey 2012 2013."},{"key":"e_1_2_5_12_1","unstructured":"Medecins Sans Frontieres.Khayelitsha 2001\u20132011 Activity Report: 10\u00a0years of HIV\/TB care at primary health care level 2011."},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0013901"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.13.0742"},{"key":"e_1_2_5_15_1","unstructured":"Medecins Sans Frontieres.Scaling up diagnosis and treatment of drug\u2010resistant tuberculosis in Khayelitsha South Africa 2011."},{"key":"e_1_2_5_16_1","unstructured":"Statistics South Africa.Statistical Release P0141 Consumer Price Index February 2012. Pretoria South Africa 2012. (Available from:http:\/\/www.statssa.gov.za\/publications\/P0141\/P0141February2012.pdf) [14 October 2014]."},{"key":"e_1_2_5_17_1","unstructured":"Statistics South Africa.Statistical Release P0141 Consumer Price Index February 2013 Pretoria 2013. 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