| A recent report by the World Health Organization (WHO) released the data of multi-drug resistance (MDR) to anti-tuberculosis (TB) drug among 38 nations and regions, in which China has been on the list of particularly alarming nations. China was identified in the report as one of the key areas for the deadly infectious disease.According to the 4th National TB Survey in 2000 in China, the initial and acquired drug resistance rates were 18.6% and 46.5%, respectively, and the overall drug resistance rate was 27.8%. The increasing of drug resistance cases, particularly of the multi-drug resistance cases was the serious problem faced by TB control program of China. It would seriously influence the cure rate of chemotherapy applied to tuberculosis patients. And the treatment expense was very high. According to WHO estimated, two third of TB patients today was in danger of becoming drug resistance cases, and 50 million people were infected by multi-drug resistance tuberculosis strains.A retrospective survey was carried out in 15 counties where a global drug-resistance surveillance of TB project of the World Health Organization and the International Union Against Tuberculosis (IUATLD) had been conducted. On the base above, the demographic characteristic, disease economic burden, disease burden and the causes resulting in re-treatment of drug-resistant TB patients have been analyzed in this study. We attempt to understand the health economic issue of drug-resistant TB in Zhejiang province, and to provide the scientific basis for formulation and improvement of TB control policy.Material and Methods15 counties were randomly selected from 30 surveillance counties of "a global drug-resistance surveillance of TB project of WHO/ IUATLD". In each counties, all completely treated cases of drug-resistance TB were selected as the drug- resistance group, and completely treated cases of drug-sensitive TB were selected as drug-sensitive group. Totally 207 cases were enrolled.A questionnaire was used do the investigation. The content in the questionnaire included: (1) general situation and treatment management, such as age, sex, education, annual income and treatment result etc. (2) the treatment charges of patients before and after being diagnosed as TB, such as the fee for treatment, examining and diagnosing, traffic, room and board, nutrition, accompany and attend, also including lost money because of absence from job and so on. (3) the disability of TB cases, such as TB influence degree and duration in working, amusing, studying, house working, procreating and so on. (4) the economic situation, demographic data, treatment and prevalence data of drug-resistance and drug-sensitive TB case.The method of economic evaluation was used to explore the disease economic burden carried by the patients' families and society. Both the disease economic burden (including individual disease economic burdens and social disease economic burdens) and the disability adjusted life year (DALY)( DALY=YLL+YLD, YLL—Years of Life Lost with premature death, YLD —Years of Lived with Disability) were used in this study.Data input and management were carried out by using Epi infor 6. 0. Statistical analysis such as Chi square test etc. was carried out with SPSS 13.0 and SAS 6. 12 software packages.ResultsThere was no significant difference in the proportion of gender, age, education,labour force and family annual income between drug-resistance and drug-sensitive TB cases. But the result indicated that the main TB cases were young and the economic situation of patients was lower.The result showed that the cure rate of drug-sensitive cases and drug-resistance cases were 79.3% and 67.5%, respectively, with a statistically significant difference (PO.05).The average family disease economic burden was 3061.5 yuan per case for drug-resistant initial treatment TB, 2103.7 yuan per case for drug-sensitive initial treatment TB, 8414.0 yuan per case for drug-resistant re-treatment TB and 6798.1 yuan per case for drug-sensitive re-treatment TB. Whether initial treatment TB or re-treatment TB, the treatment charge of drug-resistant TB was higher than drug-sensitive TB with a statistically significant difference (PO.05).The social direct disease economic burden of a drug-resistant TB patient was 5549.68 yuan per case for drug-resistant TB, 2896.13 yuan per case for drug-sensitive TB. drug-resistant TB was 1.9 times higher than drug-sensitive TB with a statistically significant difference (P<0.05).The social indirect disease economic burden of a drug-resistant TB patient was 7664.53 yuan per case for drug-resistant initial treatment TB, 2372.57 yuan per case for drug-sensitive initial treatment TB, 1032.66 yuan per case for drug-resistant re-treatment TB and 4576.58 yuan per case for drug-sensitive re-treatment TB. Drug-resistant initial treatment TB was 3.2 times higher than drug-sensitive initial treatment TB. Drug-resistant re-treatment TB was 2.3 times higher than drug-sensitive re-treatment TB.The average social disease financial burden of a drug-resistant initial treatment TB patient was 144655.30 yuan, that of drug-sensitive initial treatment TB was 5740.68 yuan, and drug-resistant TB was 2.6 times higher than drug-sensitive TB.The average DALY of initial cases with drug-sensitive and drug-resistant TB and retreated cases with drug-sensitive and drug-resistant TB, were 0.26 person year, 0.68 person year, 0.49 person year, and 1.04 person year, respectively. The average DALY loss of drug-resistant TB patients was 0.88 and that of drug-sensitive TB patients was0.31. and it exceeded the drug-sensitive TB patient's by 0.57.ConclusionsTuberculosis is chronic infectious disease. Drug resistant strains of TB are becoming common. Two thirds of TB cases was in groups aged 18-50 years who were main labore force of families.After suffering from TB, cases showed various degrees of disability in working, amusing, studying, house working, procreating and so on. And have a bigger disease economic burden to the family and society. But in recent years, the increasing of drug resistance cases, particularly the multi-drug resistance cases was new problem faced by TB control program. Because of high failed rate of treatment, high mortality rate, high treatment expense and more difficult to management, both the family and social economic burdens of drug-resistant TB were much higher than that of drug-sensitive TB. In re-treatment cases, the ratio of the treatment expense to annual family income was 1.98-2.24 times. The values of DALY for initial and retreated cases with drug-resistant TB were 2 times higher than those for patients with drug-sensitive TB, indicating the higher disease burden in drug-resistant TB patients.Therefore, based on the results above, in order to relieve the economic burden and the disease burden of TB patients, we should pay more attention to the prevalence and spread of drug resistance tuberculosis , especially of multi-drugs resistance tuberculosis. We must take initiative in TB control to manage initial treatment of TB patients and reduce the number of drug resistant TB patient with the standardized chemical therapy and management for drug-resistant TB protocols.
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