Cost Savings Associated with Implementation of the MTBDRplus Assay in the Republic of Georgia Open Access

Ramshaw, Rebecca (2017)

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A major barrier to the elimination of tuberculosis (TB) in the country of Georgia is the high prevalence of mutli-drug resistant tuberculosis (MDR-TB). Not only does MDR-TB pose a significant threat to public health, it also requires costly treatments that drain limited financial resources. This thesis conducts a cost savings analysis to determine the effect of MTBDRplus on overall MDR-TB treatment costs, compared to conventional diagnosis alone. The primary outcome of interest is the potential cost savings associated with implementation of the MTDRplus molecular test among adult sputum smear-positive patients with MDR-TB in Georgia. This study is particularly relevant, as Georgia is currently transitioning away from Global Fund financial support and will soon be making important budgetary decisions regarding healthcare spending. Financial information was collected from Georgia's Global Fund office and the National Center for Tuberculosis and Lung Disease (NCTLD) in Tbilisi. Patient data were collected from medical records at the NCTLD. Approximately half of the records pre-dated introduction of MTBDRplus testing (March 2009 to May 2010) while the other half were consecutively collected immediately following MTBDRplus implementation (June 2010 to October 2012). Compared to conventional diagnosis, the MTBDRplus molecular test demonstrated an ability to reduce expenses at several stages of MDR-TB treatment, including hospitalization, outpatient treatment, and TB drug therapy. The median cost of treatment for one pre-implementation patient was significantly higher than the cost of treatment for one post-implementation patient ($13,216.19 compared to $9,320.55, respectively). Importantly, the two largest cost drivers were determined to be hospitalization and second line TB drug treatment. The government of Georgia should continue its investment into MTBDRplus; while the molecular diagnostic machine is relatively expensive, subsequent cost savings far outweigh the initial cost. Additionally, as a way to improve clinical outcomes and further reduce healthcare expenses, the government of Georgia should look to emerging global research that documents impact and effectivenness of shortened MDR-TB treatment regimens.

Table of Contents

1.1 Problem Statement 3
1.2 Purpose Statement 6
1.3 Significance 7
1.4 Definitions 7

2.1 Epidemiology of Tuberculosis 10
2.1.1 Epidemiology of Multi-Drug Resistant Tuberculosis 11
2.2 Multidrug Resistant Tuberculosis in Georgia 13
2.2.1 Tuberculosis Prevention and Control Efforts in Georgia 14
2.3 Economic Costs 15
2.3.1 AFB Sputum Smear Microscopy, Culture, and DST 15
2.3.2 GenoType MTBDRplus Assay 16
2.3.3 Funding Sources 18

3.1 Methodology 20
3.1.1 Introduction 20
3.1.2 Population 20
3.1.3 Research Design 21
3.1.4 Procedures 22
3.1.5 Data Analysis 27
3.2 Results 28
3.2.1 Patient Characteristics 28
3.2.2 Comparing Pre- and Post-MTBDRplus Implementation Findings 29
3.2.3 Cost Savings Trends by Annual Incidence 32

4.1 Discussion 33
4.1.1 Hospitalization 34
4.1.2 Drug Therapy 34
4.1.3 Inpatient vs. Outpatient Treatment 36
4.1.4 Funding Mechanisms and Challenges 37
4.1.5 Limitations 39
4.2 Conclusion and Recommendations 40

References 54

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