ArticleSouth African family practice : official journal of the South African Academy of Family Practice/Primary Care2026
A historical budget impact and expenditure analysis of meropenem and clavulanate-based treatment for adults with XDR-TB at a specialised TB hospital in South Africa.
Article in South African family practice : official journal of the South African Academy of Family Practice/Primary Care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundExtensively drug-resistant tuberculosis (XDR-TB) remains a major public health challenge in South Africa. Treatment options are costly and often require prolonged hospital stays. Assessing the cost of meropenem and clavulanate-based regimens can help guide resource allocation and policy.
methodsA retrospective chart analysis was conducted of adults aged 18-70 years with XDR-TB and treated with meropenem and clavulanate-based regimens between January 2018 and July 2023 at a specialised Tuberculosis (TB) hospital. Data sources included the hospital pharmacy dispensing system, National Health Laboratory Services billing records and the Electronic Drug-Resistant Tuberculosis Register. A budget impact model was developed from the payer's perspective using Microsoft Excel. Descriptive and inferential statistics were applied to assess costs related to hospitalisation, medication and laboratory diagnostics.
resultsA total of 62 patients met the inclusion criteria. The mean age was 39.5 years (95% confidence interval [CI]: 37.2-41.8), with 66.1% being male (n = 41). HIV co-infection was present in 40 patients (64.5%). The mean direct medical cost per patient for the 6-month inpatient phase was R559268.78 (≈$30 198) (95% CI: R515786.56 - R602751.00; standard deviation [s.d.]: R172653.48). Hospitalisation accounted for 87.1% of the total cost, medicines 11.9% and laboratory monitoring less than 1%, resulting in a total budget impact of R30.7 million (≈$1.66 million). Hospitalisation costs increased across the study period, and the year of initiating treatment was strongly associated with hospitalisation cost (R2 = 0.91), reflecting annual adjustments in the hospital's patient day equivalent tariffs rather than inflation alone.
conclusionTreatment of XDR-TB with meropenem and clavulanate-based regimens places a significant financial burden on the public health sector. Decentralised care, reduced inpatient duration and optimised procurement could reduce costs.Contribution: This study quantifies the cost of XDR-TB treatment in South Africa, highlighting hospitalisation as the main cost driver. Findings can guide improved budgeting, policy and service delivery in TB management.
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