Health-service costs for the treatment of multidrug-resistant/rifampicin-resistant tuberculosis in children in South Africa: application of a real-world dataset

Background Children with multidrug-resistant (MDR) / rifampicin-resistant (RR)-tuberculosis (TB) are an important but neglected group in cost-effectiveness research. Digital health information systems enable new approaches to health-service cost analysis. The Provincial Health Data Centre (PHDC) in the Western Cape, South Africa, collates disparate health system data including hospital inpatient and outpatient data, medication, laboratory tests, and primary healthcare utilisation.

Cost analysis was conducted using anonymised, integrated PHDC data for children with MDR/RR-TB between 1 January 2018 and 31 December 2021. Health-service costs were assessed by patient and disease characteristics including age, sex, drug susceptibility type, site of disease, and HIV status.

There was significant cost variation across the n=271 children in the data sample (median US$7,576 (IQR $2,725 - $22,986)). The distribution of total per patient costs fitted a gamma distribution (mean US$13,435, α = 0.93, β = 14,496). Regression analysis indicates age, disease site, living with HIV, and treatment duration had significant impact on costs, whereas the impact of resistance profile and sex was not significant.

Treatment for MDR/RR-TB in children remains costly for health systems. Utilising routinely collected, real-world data from an established health information system enables accurate and representative insights to overall costs and major cost drivers. Costs were highly skewed, with a small proportion of patients incurring very high costs. This cost analysis can assist in decision-making and programme development at local and international levels and as an input to secondary analysis. Key points Health-service costs of treating children who have drug resistant tuberculosis can be high, but the cost vary widely among patients Key factors that affect costs are age, the site of the tuberculosis disease, whether the child has HIV, and the length of time that a child receives treatment. Treating children in hospital is a major component of costs, indicating that programs or treatments that can reduce hospitalisation are likely to reduce costs. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study gained ethics approval from the Stellenbosch University Health Research Ethics Committee (no. N20/09/102) and approval from the Western Cape Department of Health and Wellness (reference: WC_202109_004). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes The authors have no interests to declare. This study was self-funded within the Desmond Tutu TB Centre, University of Stellenbosch, Cape Town, South Africa. All data produced in the study beyond that presented in the Supplementary Appendix are available upon reasonable request to the authors and on approval of the Provincial Health Data Centre of the Western Cape Government Department of Health and Wellness, South Africa. Data Availability All data produced in the present study are available upon reasonable request to the authors and on approval of the Provincial Health Data Centre of the Western Cape Government Department of Health and Wellness, South Africa.