Infection Control & Hospital Epidemiology Table 2. Doses and Regimens for Drug-Sensitive and Drug-Resistant Tuberculosis and Cost of Treatment Cost Regimen and Dose


Drug-Sensitive TBa Pulmonary: 6-mo therapy 4 drugs for 2 mo (INH, rifampicin, ethambutol, pyrazinamide) 2 drugs for 4 mo (INH, rifampicin) vitamin B6, 6 mo Total


Extra-pulmonary: 12-mo therapy 4 drugs, 2 mo (INH, rifampicin, ethambutol, pyrazinamide) 2 drugs, 10 mo (INH, rifampicin) vitamin B6, 12 mo Total


MDR-TB


Amikacin, 750mg IV Q24H Moxifloxacin, 400mg PO Q24H Pyrazinamide, 1,000mg PO Q24H Ethionamide, 1,000mg PO Q24H Cycloserine, 1,000mg PO Q24H All 5 drugs, 6 mo


4 drugs (amikacin IV excluded), 12–18 mo Total


116 27 10 64


200 75,060


108,360–162,540 183,420–237,600


1.60 0.37 0.14 0.88 2.76


1,035.11


1,494.34–2,241.51 2,529.45–3,276.62


Note. Rs., Indian rupees; TB, tuberculosis; MDR, multidrug-resistant; IV, intravenous; PO, per oral; Q24H, per 24-hour period. aAdult standard dose: INH, 300mg PO Q24H (5 mg/kg); rifampicin, 600mg PO Q24H (<50 kg: 450mg PO Q24H) (10 mg/kg); pyrazinamide, 2000mg PO Q24H (<50 kg: 1500mg PO Q24H) (15–30 mg/kg); ethambutol, 1200mg PO Q24H (<55 kg: 800mg PO Q24H) (15 mg/kg).


$35, the mean indirect cost per patient was US$527, and the total mean cost per patient was US$563.5 Of the smear-positive TB patients, 25% had to be admitted to the hospital, at a mean cost of $279 per admission.5 Our study showed a higher admission rate (38%) but a similar admission cost compared to the southern Indian study, despite the fact that our cohort had sicker patients (due to cancer-related comorbidities) and that our hospital is a not-for-profit private trust. In a Turkish series of 16 cases of TB with cancer, 5 patients (31.3%) died during treatment, a mortality rate significantly greater than in our cohort (3.4%).6 The mean total spending on hospitalization for tuberculosis


has been estimated to be Rs. 13,121 (US$202) in India, with 99.9% being out-of-pocket expenditure by patients.7 However, our study revealed a higher expenditure (US$258). In India, for cancer treatment, the total mean cost of hospitalization was reported to be Rs. 62,349 ($860), but 8.2% reimbursement was received from the government.7 In an Indian study from Tamil Nadu on patients with pulmonary tuberculosis, patients experienced a median of 6 days of time to treatment initiation and 21 days of health system delay.8 Between 2012 and 2016, the mycobacter- iology workload in our hospital increased from 258 to 651


samples (an increase of 152%), and new patient registrations increased from 10,606 to 15,479 (an increase of 45%). In parallel, the hospitalization rate in India due to tuberculosis increased by 24% (all ages combined) from 1995 to 2014, whereas for cancer a 216% increase occurred during the same period.7 In conclusion, the current study provides insight regarding the cost of TB management under the wider spectrum of cancer care. Hospita- lization rates due to TB and cancer in India are 50 and 87 per 100,000 population, respectively, and TB continues to be an important infection in oncology patients. The economic impact of TB needs to be factored in while planning healthcare resource requirements of patients with cancer.


Acknowledgments. This study was conducted as part of the Tata Social Internship Program.


Financial support. No financial support was provided relevant to this article.


Conflicts of interest. All authors report no conflicts of interest relevant to this article.


Supplementary materials. To view supplementary material for this article, please visit https://doi.org/10.1017/ice.2018.284


Rs. USD


123


1,140 1,020 288


2,448


1,140 2,550 576


4,266


15.72 14.07 3.97


33.76


15.72 35.17 7.94


58.83


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