TB’s return comes with high costs

Marketplace Staff Sep 8, 2008

TB’s return comes with high costs

Marketplace Staff Sep 8, 2008


KAI RYSSDAL: Chances are that if you think about tuberculosis — if you think about TB at all — vague images of it being a problem back in you grandparents’ time come to mind. If so, it’s time for a refresher. Worldwide, tuberculosis is back — to the tune of more than 9 million new cases a year, with a global price tag for treatment and lost productivity approaching $3 billion.

An increasing number of those cases are what’s known as multi-drug-resistant TB, or MDR. Just like it sounds, MDR TB is extremely difficult and expensive to treat. It’s taken root in parts of Eastern Europe, Romania and Ukraine, in particular. Which is where Frank Browning went for this first of two reports.

FRANK BROWNING: Five days a week medical aide Dan Bestiou drives through Bucharest’s potholed back alleys to fight the TB epidemics, bringing shots and pills to at least 30 different patients.

Dan Bestiou: Now go from one family, name is Calugaru, and this family have three patients. This TB is MDR TB.

Constantino, the father, plus Tatiano and Valentino, both in their 20s. All have been sick with drug-resistant TB since late last year. They live with four other family members in two rooms. Valentino takes daily injections. He pulls down his pants and rolls onto his stomach.

BROWNING: It hurts?

VALENTINO: It’s terrible.

It will be another year before the three can return to work. We go upstairs to see another man in the same building who is also sick with MDR TB.

BESTIOU: This is a young man and a student.

His name is also Constantino. He fell sick last fall.

CONSTANTINO: The person that give me the TB is on seventh floor. He’s my neighbor.

BROWNING: So life is tough now?

CONSTANTINO: Life sucks now.

BROWNING: And what are the effects from the treatment?

CONSTANTINO: When I take them, my stomach hurts. I get dizzy. Nausea. . . .

But it was worse for his young neighbor who quit taking the drugs, developed MDR, switched to herbal medicine, and died.

That’s the human side of Europe’s TB epidemic. Then there’s the financial cost for treating MDR TB.

Franque Grimard: $240 to $300.

Per patient, per day estimates health economist Franque Grimard. For the two years of treatment it comes to about $20,000 per person. Much of that treatment is picked up in Romania by the UN Global Fund.

GRIMARD: So these are the costs due to the illness itself.

Political disarray has prevented Global Fund support next door in Ukraine where Grimard estimates that TB costs the country more than $75 million a year in direct health care costs. And then there are also other costs.

GRIMARD: If people were not sick, there would actually be better opportunities for these people to contribute to the economy, by their spending, by working, by contributing to the national income.

Put another way, Grimard estimates that every 10 percent reduction in TB caseloads yields about 2 percent in aggregate economic growth. In short, the hard-money benefits would easily surpass the cost of the cure.

TB in Eastern Europe, however, wasn’t always so bad. TB incidence dropped dramatically under the old Soviet system, but that bounced back three-fold following the Soviet collapse. The whole system simply fell apart, says Katya Gazzinha, who works with a Seattle-based health care company, PATH, which trains doctors and lab techs.

Katya Gazzinha: And what we had, especially at the end of the 90s, was ruin. Laboratory network . . . it was not very strong before the end of 80s, but at the end of 90s it [was] simply ruined.

In a corridor of Bucharest’s TB hospital doctors Domnica Chiotan and Cristian Didilesco paused to talk about what happened. It wasn’t only the collapse of TB care, they said, it was also the effect of massive stress on people’s lives caused by the total dysfunction of the old system. That, in turn, degraded people’s immune systems.

Cristian Didilesco: Political stress. Stress of Life.

Domnica Chiotan: Unemployment. Divorcing people.

Of course, all that may seem terribly far away to most Americans. But Marcos Espinal, who directs the World Health Organization’s anti-TB Partnership, says that would be a dangerous illusion.

Marcos Espinal: TB can be acquired in flights of more than six hours. I mean, you take a plane in London today and six hours later you are in New York. Technically, you can get tuberculosis if you are sitting around the two rows that a person with tuberculosis might be sitting.

Most increases in TB remain among the poor, but a rising proportion of cases, including MDR TB, are hitting the middle class. Just this spring, New York, San Francisco and California’s Silicon Valley all reported TB increases. As more and more people take to the skies in more and more crowded planes and airports, the prospects are sobering.

I’m Frank Browning for Marketplace.

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