AN EFFECTIVENESS AND COST-ANALYSIS OF PRESUMPTIVE TREATMENT FOR MYCOBACTERIUM-TUBERCULOSIS

Background: Delay in treatment of tuberculosis has contributed to both the spread of tuberculosis and its case fatality rate. Methods: Decis ion analysis was used to examine the effectiveness and cost of presump tive treatment in patients evaluated for tuberculosis. Results: Over a range of assumptions, empiric antituberculous therapy for acid-fast b acillus smear-positive persons lowers mortality and cost per person ev aluated when available rapid diagnostic laboratory methods for tubercu losis are used. In contrast, the average cost per life saved by giving presumptive treatment to all acid-fast bacillus smear- and HIV-negati ve patients exceeds $1 million. Empiric treatment for HIV-infected pat ients with acid-fast bacillus-negative smears decreases average mortal ity by 2% at an additional cost of $8000 per life saved. When the prev alence of multiple-drug resistance exceeds 9.6%, presumptive drug-resi stant therapy for acid-fast bacillus smear-positive patients, rather t han the initial four-drug regimen recommended for much of the United S tates, minimizes both mortality and costs. Conclusions: Empiric antitu berculous therapy often minimizes average mortality and cost for patie nts evaluated for tuberculosis when rapid diagnostic methods are used.