The Economic Burden
TB is one of the deadliest and most disabling diseases in the world today. Although its burden is spread across all age groups, it exacts its greatest toll on individuals during their most productive years, from ages 15 to 44. The impact of TB on families is often economically devastating. The difficulties of taking care of sick individuals usually falls to other family members, putting them at greater risk of infection, lowering their productivity and perpetuating the cycle of poverty.
The emergence and spread of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), now found in all countries surveyed worldwide, are confounding global efforts to halt the spread of TB and are imposing an enormous economic burden on health systems globally. The cost of treating MDR-TB can be 200 times greater than for drug-susceptible TB. Around the world, the economic toll of TB on individuals and public health budgets is significant:
- In Europe alone, the costs of treatment and lost productivity total nearly €6 billion every year.
- In all 27 countries with a high burden of MDR-TB, expenditure for MDR-TB treatment exceeds gross national income per capita.
- In Germany, the mean outpatient costs per case were €1,197 for standard TB treatment, but €36,543 for MDR-TB treatment.
- A study in Ghana, Vietnam and the Dominican Republic found that despite tuberculosis diagnosis and treatment being provided for free, the average total patient costs were equivalent to approximately one year of individual income, due largely to hospital costs and additional food items during treatment.
- Despite drug-resistant TB comprising only 2.2 percent of South Africa’s case burden, it consumed around 32 percent of the total estimated 2011 national budget of US $218 million.
- In the United States, the cost of hospitalization for one XDR-TB patient is estimated to average $483,000 - twice the cost for MDR-TB and nearly 25 times the average for all primary hospital stays for TB.
- In the early 1990s, an outbreak of MDR-TB struck New York City, costing at least US $1 billion to treat patients and prevent further spread of the disease.
- In the United Kingdom, it costs around £5,000 per patient to treat drug-susceptible tuberculosis, but £50,000 to £70,000 per patient to treat drug-resistant TB.
- The annual cost of MDR-TB treatment for all of Russia would amount to US $375 million.
- The cost of treating XDR-TB patients in Australia is between $500,000 and $1 million per patient.
Making new TB vaccines available to the world over the next 10-15 years is estimated to cost in the range US $600 million to $1 billion, depending on the probability of success of the different candidates. These costs pale in comparison to the estimated US $8 billion a year required to provide TB treatment and care. Considering the cost of TB control strategies, with only minor reductions in TB incidence expected in the coming years, the relative cost to develop new TB vaccines is nominal given the massive potential.
According to Esther Pronker and her colleagues in the March 2013 issue of PLoS, “Immunization strategies – of which the use of vaccines is the most important – have prevented more premature deaths, permanent disability, and suffering, in all regions of the world, than any other medical invention.”