{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:08:21Z","timestamp":1785431301412,"version":"3.56.0"},"reference-count":26,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Extensively drug-resistant tuberculosis (XDR-TB) remains a major public health challenge in South Africa. Treatment options are costly and often require prolonged hospital stays. Assessing the cost of meropenem and clavulanate-based regimens can help guide resource allocation and policy.\nMethods:\u00a0A retrospective chart analysis was conducted of adults aged 18\u201370 years with XDR-TB and treated with meropenem and clavulanate-based regimens between January 2018 and July 2023 at a specialised Tuberculosis (TB) hospital. Data sources included the hospital pharmacy dispensing system, National Health Laboratory Services billing records and the Electronic Drug-Resistant Tuberculosis Register. A budget impact model was developed from the payer\u2019s perspective using Microsoft Excel. Descriptive and inferential statistics were applied to assess costs related to hospitalisation, medication and laboratory diagnostics.\nResults:\u00a0A total of 62 patients met the inclusion criteria. The mean age was 39.5 years (95% confidence interval [CI]: 37.2\u201341.8), with 66.1% being male (n\u00a0= 41). HIV co-infection was present in 40 patients (64.5%). The mean direct medical cost per patient for the 6-month inpatient phase was R559268.78 (\u2248$30 198) (95% CI: R515786.56 \u2013 R602751.00; standard deviation [s.d.]: R172653.48). Hospitalisation accounted for 87.1% of the total cost, medicines 11.9% and laboratory monitoring less than 1%, resulting in a total budget impact of R30.7 million (\u2248$1.66 million). Hospitalisation costs increased across the study period, and the year of initiating treatment was strongly associated with hospitalisation cost (R2\u00a0= 0.91), reflecting annual adjustments in the hospital\u2019s patient day equivalent tariffs rather than inflation alone.\nConclusion:\u00a0Treatment of XDR-TB with meropenem and clavulanate-based regimens places a significant financial burden on the public health sector. Decentralised care, reduced inpatient duration and optimised procurement could reduce costs.\nContribution:\u00a0This study quantifies the cost of XDR-TB treatment in South Africa, highlighting hospitalisation as the main cost driver. Findings can guide improved budgeting, policy and service delivery in TB management.<\/jats:p>","DOI":"10.4102\/safp.v68i1.6252","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T05:45:06Z","timestamp":1772516706000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A historical budget impact and expenditure analysis of meropenem and clavulanate-based treatment for adults with XDR-TB at a specialised TB hospital in South Africa"],"prefix":"10.4102","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0283-7778","authenticated-orcid":false,"given":"Bandela","family":"Mgoqi","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7601-0649","authenticated-orcid":false,"given":"Shelley-Ann","family":"McGee","sequence":"additional","affiliation":[{"name":"Insight Health Solutions, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8559-9168","authenticated-orcid":false,"given":"Fatima","family":"Suleman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref0","unstructured":"World Health Organization. Global tuberculosis report 2022 [homepage on the Internet]. Geneva: WHO; 2022 [cited 2025 Oct 06]. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240061729"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Lange C, Chesov D, Heyckendorf J, Leung CC, Udwadia Z, Dheda K. Drug-resistant tuberculosis: An update on disease burden, diagnosis and treatment. Respirology. 2018;23(7):656\u2013673. https:\/\/doi.org\/10.1111\/resp.13304","DOI":"10.1111\/resp.13304"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Naidoo P, Theron G, Rangaka MX, et al. The South African tuberculosis care cascade: Estimated losses and methodological challenges. J Infect Dis. 2017;216(suppl_7):S702\u2013S713. https:\/\/doi.org\/10.1093\/infdis\/jix335","DOI":"10.1093\/infdis\/jix335"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Dheda K, Gumbo T, Maartens G, et al. The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. Lancet Respir Med. 2017;5(4):291\u2013360. https:\/\/doi.org\/10.1016\/S2213-2600(17)30079-6","DOI":"10.1016\/S2213-2600(17)30079-6"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Bloemberg GV, Gagneux S, B\u00f6ttger EC. Acquired resistance to bedaquiline and delamanid in therapy for tuberculosis. N Engl J Med. 2015;373(20):1986\u20131988. https:\/\/doi.org\/10.1056\/NEJMc1505196","DOI":"10.1056\/NEJMc1505196"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Nimmo C, Millard J, Brien K, et al. Bedaquiline resistance in drug-resistant tuberculosis HIV co-infected patients. Eur Respir J. 2020;55(6):1902383. https:\/\/doi.org\/10.1183\/13993003.02383-2019","DOI":"10.1183\/13993003.02383-2019"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Tiberi S, Du Plessis N, Walzl G, et al. Tuberculosis: Progress and advances in development of new drugs, treatment regimens, and host-directed therapies. Lancet Infect Dis. 2018;18(7):e183\u2013e198. https:\/\/doi.org\/10.1016\/S1473-3099(18)30110-5","DOI":"10.1016\/S1473-3099(18)30110-5"},{"key":"ref7","unstructured":"Salmon-Rousseau A, Alvarez-Lerma F, Alvarez-Sala R, Timsit JF. Meropenem: A review of its use in intensive care units. Expert Rev Anti Infect Ther. 2020;18(7):639\u2013648. https:\/\/doi.org\/10.1080\/14787210.2020.1757395"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Livermore DM. Beta-lactamases in laboratory and clinical resistance. Clin Microbiol Rev. 1995;8(4):557\u2013584. https:\/\/doi.org\/10.1128\/CMR.8.4.557","DOI":"10.1128\/CMR.8.4.557"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Hugonnet JE, Tremblay LW, Boshoff HI, Barry CE 3rd, Blanchard JS. Meropenem-clavulanate is effective against extensively drug-resistant Mycobacterium tuberculosis. Science. 2009;323(5918):1215\u20131218. https:\/\/doi.org\/10.1126\/science.1167498","DOI":"10.1126\/science.1167498"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Payen MC, De Wit S, Martin C, et al. Clinical use of the meropenem-clavulanate combination for extensively drug-resistant tuberculosis. Int J Tuberc Lung Dis. 2018;22(4):404\u2013408. https:\/\/doi.org\/10.5588\/ijtld.11.0414","DOI":"10.5588\/ijtld.18.0055-2"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Sotgiu G, D\u2019Ambrosio L, Centis R, et al. Carbapenems to treat multidrug and extensively drug-resistant tuberculosis: A systematic review. Int J Mol Sci. 2016;17(3):373. https:\/\/doi.org\/10.3390\/ijms17030373","DOI":"10.3390\/ijms17030373"},{"key":"ref12","unstructured":"National Department of Health. Management of rifampicin-resistant tuberculosis: A clinical reference guide. Pretoria: National Department of Health; 2019."},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Mauskopf JA, Sullivan SD, Annemans L, et al. Principles of good practice for budget impact analysis: Report of the ISPOR Task Force on good research practices \u2013 Budget impact analysis. Value Health. 2007;10(5):336\u2013347. https:\/\/doi.org\/10.1111\/j.1524-4733.2007.00187.x","DOI":"10.1111\/j.1524-4733.2007.00187.x"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Sullivan SD, Mauskopf JA, Augustovski F, et al. Budget impact analysis \u2013 Principles of good practice: Report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value Health. 2014;17(1):5\u201314. https:\/\/doi.org\/10.1016\/j.jval.2013.08.2291","DOI":"10.1016\/j.jval.2013.08.2291"},{"key":"ref15","unstructured":"National Department of Health (South Africa). EDRWeb: Electronic Drug-Resistant Tuberculosis Register [homepage on the Internet]. Pretoria: NDoH; c2025 [cited 2025 Oct 04]. Available from: https:\/\/www.edrweb.net"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Horton KC, MacPherson P, Houben RM, White RG, Corbett EL. Sex differences in tuberculosis burden and notifications in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med. 2016;13(9):e1002119. https:\/\/doi.org\/10.1371\/journal.pmed.1002119","DOI":"10.1371\/journal.pmed.1002119"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Onozaki I, Law I, Sismanidis C, Zignol M, Glaziou P, Floyd K. National tuberculosis prevalence surveys in Asia, 1990\u20132012: An overview of results and lessons learned. Trop Med Int Health. 2015;20(9):1128\u20131145. https:\/\/doi.org\/10.1111\/tmi.12534","DOI":"10.1111\/tmi.12534"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Schnippel K, Rosen S, Shearer K, et al. Costs of inpatient treatment for multi-drug-resistant tuberculosis in South Africa. Trop Med Int Health. 2013;18(1):109\u2013116. https:\/\/doi.org\/10.1111\/tmi.12018","DOI":"10.1111\/tmi.12018"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Loveday M, Wallengren K, Reddy T, et al. MDR-TB patients in KwaZulu-Natal, South Africa: Cost-effectiveness of 5 models of care. PLoS One. 2018;13(4):e0196003. https:\/\/doi.org\/10.1371\/journal.pone.0196003","DOI":"10.1371\/journal.pone.0196003"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Gomez GB, Gupta S, Sy DN, et al. The cost-effectiveness of the BPaL regimen for the treatment of extensively drug-resistant tuberculosis in three high-burden countries. PLoS Glob Public Health. 2021;1(10):e0000021. https:\/\/doi.org\/10.1371\/journal.pgph.0000021","DOI":"10.1371\/journal.pgph.0000021"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Fekadu G, Yao J, You JHS. Bedaquiline-based treatment for extensively drug-resistant tuberculosis in South Africa: A cost-effectiveness analysis. PLoS One. 2022;17(8):e0272770. https:\/\/doi.org\/10.1371\/journal.pone.0272770","DOI":"10.1371\/journal.pone.0272770"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Masuku SD, Berhanu R, Van Rensburg C, et al. Managing multidrug-resistant tuberculosis in South Africa: A budget impact analysis. Int J Tuberc Lung Dis. 2020;24(4):376\u2013382. https:\/\/doi.org\/10.5588\/ijtld.19.0409.","DOI":"10.5588\/ijtld.19.0409"},{"key":"ref23","unstructured":"World Health Organization. WHO consolidated guidelines on tuberculosis: Module 4: treatment \u2013 Drug-resistant tuberculosis treatment [homepage on the Internet]. Geneva: WHO; 2020 [cited 2025 Oct 06]. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240007048"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Tiberi S, Payen MC, Sotgiu G, et al. Effectiveness and safety of meropenem\/clavulanate-containing regimens in the treatment of MDR- and XDR-TB. Eur Respir J. 2016;47(4):1235\u20131243. https:\/\/doi.org\/10.1183\/13993003.02146-2015","DOI":"10.1183\/13993003.02146-2015"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Payen MC, Muylle I, Van den Wijngaert S, et al. Meropenem-clavulanate for drug-resistant tuberculosis. Int J Tuberc Lung Dis. 2018;22(12):1382\u20131387. https:\/\/doi.org\/10.5588\/ijtld.17.0352","DOI":"10.5588\/ijtld.17.0352"}],"container-title":["South African Family Practice"],"original-title":[],"link":[{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/view\/6252\/10292","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T05:45:36Z","timestamp":1772516736000},"score":1,"resource":{"primary":{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/view\/6252"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/safp.v68i1.6252","relation":{},"ISSN":["2078-6190","2078-6204"],"issn-type":[{"value":"2078-6190","type":"print"},{"value":"2078-6204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,4]]},"article-number":"a6252"}}