Web Zap*Germs Archive

June 09, 2005

Bill for Treating Each US Case of Superbug TB: $8.72 Million

Summarizing & commenting on an 08 June WSJ article [subscr. req'd] on TB:

Immigrants to the US are the primary carriers of US cases of multidrug-resistant tuberculosis (MDR-TB), reflecting "a raging pandemic overseas." This from Dr. Reuben Granich of the CDC, in a report published today in JAMA. Though HIV patients, prisoners and homeless people still are at risk of MDR-TB, America's TB is increasingly imported.

MDR-TB in the US has dropped 76% since 1993, and California has the largest concentration of US MDR-TB cases, according to the Granich report. Its 37 cases in 2004 were one-third of the US's total. The bulk of California's multidrug-resistant TB cases involves people born outside the U.S., the JAMA study said. Imported MDR-TB is more difficult to treat, says the WSJ, because these immigrants are "immigrants are often poor, frightened and prone to move frequently." I suppose that's their way of saying that the MDR-TB patients are "undocumented workers," else they wouldn't be "frightened."

What's amazing is how expensive it is -- for US taxpayers -- to treat each of the 37 California cases, as well as 120 additional people who developed latent infections from them: $8.72 million in direct medical costs and contact tracing, plus administrative expenses.

Why so expensive? While treatment of regular TB takes six months at a cost of about $2,000 of standard antibiotics, MDR-TB requires 18 to 36 months of expensive -- and often toxic -- second-line drugs. These cost between $28,000 and $1.2 million per patient.

This sentence set me to pondering: "Dr. Granich said it is crucial to care for immigrants and enhance TB care overseas rather than close borders." I'll bet that $8.72 million per MDR-TB patient would go a lot farther if spent to eradicate TB overseas, where the disease is "pandemic." Plus, we don't have to close our borders -- just monitor them a whole lot better. Otherwise, the world's solution to TB will be to export their TB carriers to California as undocumented workers, knowing it will spend up to $8.72 million to find and cure each one.


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