Cost of the Adverse Events of the Various Chemotherapy Regimens for the Multidrug Resistant Tuberculosis

In order to comparatively assess the amount of costs for the relief of the most common adverse reactions (AE) in different treatment regimens of patients with tuberculosis with multiple and broad drug resistance (MDR and XDR) of the causative agent, an analysis of the frequency, spectrum, severity and cost of relief of all AE developed against the background of chemotherapy of 239 tuberculosis patients with MDR, divided into three groups: I – 82 patients treated in 2011-2015 using only anti-tuberculosis drugs (ATD) of the main and reserve series; II – 77 patients in whom, in addition to these ATD, linezolid was included in the treatment regimen; III – 80 patients treated with linezolid and bedaquiline with ATD of the main and reserve series. The cost–effectiveness analysis used to identify the most economically effective chemotherapy regimen. Results . 564 AE episodes were registered in 220 patients (92.1%, 95% CI 87.9–94.9%), without significant intergroup differences (92.7%, 96.1% and 87.5%, respectively, in groups I, II and III, p > 0.05). AE III–IV degrees of severity were observed in 35 patients (14.6%, 95% CI 10.7–19.7%); no significant differences in severity and frequency of individual types of AE were found. The elimination of myelo-, hepato- and cardiotoxic reactions of III-IV severity required the greatest costs. The cost of cupping all AE and the cost-effectiveness ratio were the lowest in group III patients (CER = 28.9 thousand RUB compared to 41.7 thousand rubles and 40.3 thousand rubles in groups I and II, respectively). Conclusion . Тhe use of tuberculosis chemotherapy regimens with MDR /XDR pathogen with the inclusion of bedaquiline and linezolid requires the lowest total costs for the relief of adverse reactions with comparable effectiveness