Europe is facing a multi-billion-euro time bomb of rising costs to control tuberculosis (TB) as drug-resistant forms of the lung disease spread, a pioneering study found.
Often thought of as a disease of the past or one restricted to marginalized communities, TB is already inflicting annual direct costs of more than 500 million euros on the region and another 5.3 billion euros in productivity losses.
The study, by health economists based in Germany, also suggests the economic burden of TB far outweighs the likely costs of investing in much-needed research to develop more effective medicines and vaccines — something they said governments and the drug industry should do urgently.
"We know that new drugs and vaccines are very expensive [to develop], but if you take these costs into consideration, then everything is justified," said Roland Diel, a health economics professor at Germany's University Hospital Schleswig-Holstein in Kiel, who led the study.
The emergence of strains of that can't be treated with even the most powerful of drugs has turned TB into one of the world's most pressing health problems.
According to the World Health Organization (WHO), TB infected 8.7 million people worldwide in 2011 and killed 1.4 million. As many as two million people may have drug-resistant strains by 2015, the Geneva-based health agency says.
Treating even typical TB is a long process. Patients need to take a cocktail of antibiotics for six months and many fail to complete the treatment. That, alongside overuse and misuse of antibiotics, has fuelled the emergence of multidrug-resistant TB (MDR-TB) and extensively drug resistant (XDR-TB).
For this study, published online in the European Respiratory Journal on Friday and the first of its kind, researchers used a systematic review of literature and institutional websites for the 27 EU member states to summarize data on TB treatment costs in 2011.
They split the countries into two groups based on gross domestic product (GDP) per person.
For the old EU 15 countries plus Cyprus, Malta and Slovenia, the average direct cost per case of typical TB was 10,282 euros ($13,600), but was more than 57,200 euros for MDR cases and more than 170,700 euros for XDR cases. For the remaining EU states, average costs were 3,427 euros for standard treatable TB and around 24,100 euros for drug-resistant cases.
The total treatment cost of all TB cases in 2011 was 536,890,315 euros ($712.26 million).
While the number of drug-resistant TB cases in Europe is currently only a tiny fraction of the total of around 70,000 cases per year, Diel said that would swiftly change.
"It's a time bomb in terms of drug-resistant cases," he said in a telephone interview. "They are just a small fraction right now, but that will increase... so the costs will also rise."
Beyond the direct costs, Diel's team also calculated TB's impact in terms of the monetary value of lost productivity.
Using disability-adjusted life years, or DALYs — a measure of disease burden that looks at the number of years lost due to ill-health, disability or early death — they found the total years lost was 103,104 in 2011. In monetary terms, this amounted to more than 5.3 billion euros.
Diel said this was the figure that shocked him the most.
"People assume that in most parts of Europe, TB doesn't play much of a role in comparison to other diseases. But, in fact, the costs of it are very high," he said. "It's billions, and nobody realized that before."
Responding to the findings, Francesco Blasi, President of the European Respiratory Society, said they showed the huge burden of TB on both the economy and on society in Europe.
"It is critical that healthcare professionals and policymakers take note," he said in a statement.