Open Access Research

The value of effective public tuberculosis treatment: an analysis of opportunity costs associated with multidrug resistant tuberculosis in Latvia

Thaddeus L Miller1*, Andra Cirule2, Fernando A Wilson1, Timothy H Holtz3, Vija Riekstina2, Kevin P Cain4, Patrick K Moonan4 and Vaira Leimane5

Author Affiliations

1 University of North Texas Health Science Center at Fort Worth, School of Public Health, Fort Worth, TX, USA

2 State Agency Infectology Center of Latvia, Riga, Latvia

3 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

4 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA

5 World Health Organization Collaborative Center for Research and Training in Management of Multidrug-resistant Tuberculosis, State Agency Infectology Center of Latvia, Riga, Latvia

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Cost Effectiveness and Resource Allocation 2013, 11:9  doi:10.1186/1478-7547-11-9

Published: 17 April 2013



A challenge to effective protection against tuberculosis is to sustain expensive and complex treatment public programs. Potential consequences of program failure include acquired drug resistance, poor patient outcomes, and potentially much higher system costs, however. In contrast, effective efforts have value illustrated by impacts they prevent. We compared the healthcare costs and treatment outcomes among multidrug-resistant tuberculosis (MDR-TB) and non MDR-TB patients in Latvia to identify benefits or costs associated with both.


We measured and compared costs, healthcare utilization, and outcomes for patients who began treatment through Latvia’s TB control program in 2002 using multivariate regression analysis and negative binomial regression.


We analyzed data for 92 MDR-TB and 54 non MDR-TB patients. Most (67%) MDR-TB patients had history of prior tuberculosis treatment. MDR-TB was associated with lower cure rates (71% vs. 91%) and greater resource utilization. MDR-TB treatment cost almost $20,000 more than non MDR-TB.


Up to 2/3 of MDR-TB treated in our sample was preventable at a potential savings of over $1.3 million in healthcare resources as well as substantial individual health.

Tuberculosis cost; Health economics; Cost analysis; Evidence based policy