{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:12Z","timestamp":1787022072243,"version":"build-2736575974"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Global Fund New Funding Model MDR-TB Grant","award":["NGA-T-IHVN"],"award-info":[{"award-number":["NGA-T-IHVN"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Globally, drug resistant tuberculosis (DR-TB) continues to be a public health threat. Nigeria, which accounts for a significant proportion of the global burden of rifampicin\/multi-drug resistant-TB (RR\/MDR-TB) had a funding gap of $168 million dollars for TB treatment in 2018. Since 2010, Nigeria has utilized five different models of care for RR\/MDR-TB (Models A-E); Models A, B and C based on a standardized WHO-approved treatment regimen of 20\u201324 months, were phased out between 2015 and 2019 and replaced by Models D and E. Model D is a fully ambulatory model of 9\u201312 months during which a shorter treatment regimen including a second-line injectable agent is utilized. Model E is identical to Model D but has patients hospitalized for the first four months of care while Model F which is to be introduced in 2020, is a fully ambulatory, oral bedaquiline-containing shorter treatment regimen of 9\u201312 months. Treatment models for RR\/MDR-TB of 20\u201324 months duration have had treatment success rates of 52\u201366% while shorter treatment regimens have reported success rates of 85% and above. In addition, replacing the second-line injectable agent in a shorter treatment regimen with bedaquiline has been found to further improve treatment success in patients with fluoroquinolone-susceptible RR\/MDR-TB.<\/jats:p>\n                    <jats:p>Reliable cost data for RR\/MDR-TB care are limited, specifically costs of models that utilize shorter treatment regimens and which are vital to guide Nigeria through the provision of RR\/MDR-TB care at scale. We therefore conducted a cost analysis of shorter treatment regimens in use and to be used in Nigeria (Models D, E and F) and compared them to three models of longer duration utilized previously in Nigeria (Models A, B and C) to identify any changes in cost from transitioning from Models A-C to Models D-F and opportunities for cost savings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We obtained costs for TB diagnostic and monitoring tests, in-patient and out-patient care from a previous study, inflated these costs to 2019 NGN and then converted to 2020 USD. We obtained other costs from the average of six health facilities and drug costs from the global drug facility. We modeled treatment on strict adherence to two Nigerian National guidelines for programmatic and clinical management of drug-resistant tuberculosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We estimated that the total costs of care from the health sector perspective for Models D, E and F were $4,334, $7,705 and $3,420 respectively. This is significantly lower than the costs of Models A, B and C which were $14,781, $12, 113, $7,572 respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Replacing Models A\u2013C with Models D and E reduced the costs of RR\/MDR-TB care in Nigeria by approximately $5,470 (48%) per patient treated and transitioning from Models D and E to Model F would result in further cost savings of $914 to $4,285 (21 to 56%) for every patient placed on Model F. If the improved outcomes of patients managed using bedaquiline-containing shorter treatment regimens in other countries can be attained in Nigeria, Model F would be the recommended model for the scale up of RR\/MDR-TB care in Nigeria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0241065","type":"journal-article","created":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T16:01:33Z","timestamp":1606838493000},"page":"e0241065","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cost comparison of nine-month treatment regimens with 20-month standardized care for the treatment of rifampicin-resistant\/multi-drug resistant tuberculosis in Nigeria"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0212-3907","authenticated-orcid":true,"given":"Florence O.","family":"Bada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Blok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evaezi","family":"Okpokoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saswata","family":"Dutt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Akolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Dakum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alash\u2019le","family":"Abimiku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,1]]},"reference":[{"key":"pone.0241065.ref001","unstructured":"World Health Organization, \u201cGlobal Tuberculosis Report 2019,\u201d 2019."},{"issue":"10150","key":"pone.0241065.ref002","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/S0140-6736(18)31644-1","article-title":"Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis","volume":"392","author":"N. Ahmad","year":"2018","journal-title":"Lancet"},{"issue":"3","key":"pone.0241065.ref003","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S1473-3099(09)70041-6","article-title":"Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis","volume":"9","author":"E. W. Orenstein","year":"2009","journal-title":"Lancet Infect. Dis."},{"issue":"1","key":"pone.0241065.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0054587","article-title":"What is the Cost of Diagnosis and Management of Drug Resistant Tuberculosis in South Africa","volume":"8","author":"A. Pooran","year":"2013","journal-title":"PLoS One"},{"key":"pone.0241065.ref005","first-page":"44","article-title":"Guidelines for the programmatic management of Multidrug-resistant Tuberculosis.","author":"World Health Organization","year":"2006","journal-title":"World Heal. Organ."},{"issue":"1","key":"pone.0241065.ref006","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1186\/s12879-016-1802-x","article-title":"The socioeconomic impact of multidrug resistant tuberculosis on patients: results from Ethiopia, Indonesia and Kazakhstan","volume":"16","author":"S. van den Hof","year":"2016","journal-title":"BMC Infect. Dis."},{"key":"pone.0241065.ref007","first-page":"1","author":"F. O. Bada","year":"2019","journal-title":"Cost of three models of care for drug- resistant tuberculosis patients in Nigeria"},{"issue":"1","key":"pone.0241065.ref008","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1183\/09031936.00169411","article-title":"Cost and cost-effectiveness of multidrug-resistant tuberculosis treatment in Estonia and Russia","volume":"40","author":"K. Floyd","year":"2012","journal-title":"Eur. Respir. J."},{"key":"pone.0241065.ref009","first-page":"435","article-title":"Characteristics and costs of multidrug-resistant tuberculosis in- patient care in the United States, 2005\u20132007","volume":"20","author":"S. M. Marks","year":"2016"},{"issue":"6","key":"pone.0241065.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0217820","article-title":"Cost outcome analysis of decentralized care for drug-resistant tuberculosis in Johannesburg, South Africa","volume":"14","author":"C. Van Rensburg","year":"2019","journal-title":"PLoS One"},{"issue":"12","key":"pone.0241065.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0082943","article-title":"Risk factors for poor treatment outcomes in patients with MDR-TB and XDR-TB in China: Retrospective multi-center investigation","volume":"8","author":"S. Tang","year":"2013","journal-title":"PLoS One"},{"issue":"4","key":"pone.0241065.ref012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0196003","article-title":"MDR-TB patients in KwaZulu-Natal, South Africa: Cost-effectiveness of 5 models of care","volume":"13","author":"M. Loveday","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"pone.0241065.ref013","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1186\/1471-2334-14-333","article-title":"Treatment outcomes from community-based drug resistant tuberculosis treatment programs: a systematic review and meta-analysis","volume":"14","author":"P. Weiss","year":"2014","journal-title":"BMC Infect. Dis."},{"issue":"2","key":"pone.0241065.ref014","doi-asserted-by":"crossref","first-page":"271","DOI":"10.4269\/ajtmh.13-0004","article-title":"Review article: A systematic review of the effectiveness of hospital and ambulatory-based management of multidrug-resistant tuberculosis","volume":"89","author":"A. Bassili","year":"2013","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"pone.0241065.ref015","unstructured":"World Health Organization, \u201cWHO treatment guidelines for drug- resistant tuberculosis 2016,\u201d 2016."},{"issue":"May","key":"pone.0241065.ref016","first-page":"1180","article-title":"Successful \u2018 9-month Bangladesh regimen \u2018 for multidrug- resistant tuberculosis among over 500 consecutive patients","volume":"18","author":"K. J. M. Aung","year":"2014"},{"issue":"5","key":"pone.0241065.ref017","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1164\/rccm.201001-0077OC","article-title":"Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis","volume":"182","author":"A. Van Deun","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med."},{"issue":"5","key":"pone.0241065.ref018","doi-asserted-by":"crossref","DOI":"10.5588\/ijtld.14.0535","article-title":"High effectiveness of a 12-month regimen for MDR-TB patients in Cameroon","volume":"19","author":"C. Kuaban","year":"2015","journal-title":"Int. J. Tuberc. Lung Dis."},{"issue":"January","key":"pone.0241065.ref019","first-page":"1188","article-title":"High cure rate with standardised short-course multidrug- resistant tuberculosis treatment in Niger: no relapses","volume":"18","author":"A. Piubello","year":"2014"},{"key":"pone.0241065.ref020","first-page":"1","author":"J. J. Madan","journal-title":"Economic evaluation of short treatment for multidrug- resistant tuberculosis, Ethiopia and South Africa: the STREAM trial"},{"key":"pone.0241065.ref021","unstructured":"World Health Organization, \u201cWHO consolidated guidelines on tuberculosis,\u201d 2020."},{"key":"pone.0241065.ref022","first-page":"1","author":"Y. K. Avong","year":"2015","journal-title":"Doing No Harm? Adverse Events in a Nation- Wide Cohort of Patients with Multidrug- Resistant Tuberculosis in Nigeria"},{"issue":"9","key":"pone.0241065.ref023","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.5588\/ijtld.18.0626","article-title":"Rates and risk factors for nephrotoxicity and ototoxicity among tuberculosis patients in Tbilisi, Georgia","volume":"23","author":"M. Buziashvili","year":"2019","journal-title":"Int. J. Tuberc. Lung Dis."},{"issue":"8","key":"pone.0241065.ref024","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1093\/jac\/dkr221","article-title":"Multidrug-resistant tuberculosis (MDR-TB) treatment in the UK: A study of injectable use and toxicity in practice","volume":"66","author":"A. Sturdy","year":"2011","journal-title":"J. Antimicrob. Chemother."},{"issue":"9","key":"pone.0241065.ref025","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1093\/cid\/ciy727","article-title":"Improved treatment outcomes with bedaquiline when substituted for second-line injectable agents in multidrug-resistant tuberculosis: A retrospective cohort study","volume":"68","author":"Y. Zhao","year":"2019","journal-title":"Clin. Infect. Dis."},{"issue":"9","key":"pone.0241065.ref026","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/S2213-2600(18)30235-2","article-title":"Effect of bedaquiline on mortality in South African patients with drug-resistant tuberculosis: a retrospective cohort study","volume":"6","author":"K. Schnippel","journal-title":"Lancet Respir."},{"issue":"9","key":"pone.0241065.ref027","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1007\/s40273-015-0279-6","article-title":"Costs to Health Services and the Patient of Treating Tuberculosis: A Systematic Literature Review","volume":"33","author":"Y. V. Laurence","year":"2015","journal-title":"Pharmacoeconomics"},{"key":"pone.0241065.ref028","unstructured":"T. W. Bank, \u201cInflation, Consumer prices (annual %)\u2014Nigeria\u201d."},{"key":"pone.0241065.ref029","unstructured":"\u201cXE Currency coverter\u201d. [Online]. Available: https:\/\/www.xe.com\/currencyconverter\/convert\/?Amount=1&From=NGN&To=USD."},{"issue":"11","key":"pone.0241065.ref030","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1016\/j.rmed.2014.09.021","article-title":"Cost of multi drug resistance tuberculosis in Germany","volume":"108","author":"R. Diel","year":"2014","journal-title":"Respir. Med."},{"issue":"7","key":"pone.0241065.ref031","first-page":"968","article-title":"Approach Linked references are available on JSTOR for this article: Treatment of Multidrug-Resistant Tuberculo in San Francisco: An Outpatient-Based Appro","volume":"40","author":"M. Burgos","journal-title":"Oxford"},{"issue":"1","key":"pone.0241065.ref032","doi-asserted-by":"crossref","first-page":"17","DOI":"10.5588\/ijtld.17.0498","article-title":"Treatment outcome with a short multidrug-resistant tuberculosis regimen in nine African countries","volume":"22","author":"A. Trebucq","year":"2018","journal-title":"Int. J. Tuberc. Lung Dis."},{"issue":"8","key":"pone.0241065.ref033","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1177\/0091270010381498","article-title":"Population pharmacokinetic and concentration-QTc models for moxifloxacin: Pooled analysis of 20 thorough QT studies","volume":"51","author":"J. A. Florian","year":"2011","journal-title":"J. Clin. Pharmacol."},{"issue":"2","key":"pone.0241065.ref034","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s40121-013-0009-3","article-title":"A Review of the Evidence for Using Bedaquiline (TMC207) to Treat Multi-Drug Resistant Tuberculosis,\u201d","volume":"2","author":"G. J. Fox","year":"2013","journal-title":"Infect. Dis. Ther."}],"updated-by":[{"DOI":"10.1371\/journal.pone.0259492","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T00:00:00Z","timestamp":1635379200000}},{"DOI":"10.1371\/journal.pone.0321797","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0241065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T16:02:04Z","timestamp":1606838524000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0241065"}},"subtitle":[],"editor":[{"given":"Jennifer","family":"Furin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,12,1]]},"references-count":34,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0241065","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,1]]}}}