Economic Burden of Diabetic Tuberculosis Patients from 3 Malaysian Hospitals

Aim: To assess the impact of diabetes mellitus (DM) on the cost of the tuberculosis (TB) treatment.
Study Design: Prevalence based cohort.
Place and Duration of Study: Penang General Hospital, Hospital USM, and – Univesiti Malaya
Medical Center; 2005 – 2008.
Methods: Study patients were placed in the TB only, DM only, or DM-TB groups, with each group
including 200 patients. Information related to demographics, chronic disease comorbidity, duration of
hypertension (HTN) and DM, and economic variables were obtained from the patients’ medical files
both at the beginning and end of the study period. The economic burden of DM-TB patients was
assessed from hospitalization periods, frequency of clinic visits, and diagnostic requests.
Results: Durations of DM and HTN were 9.2 and 5.6 years, respectively, for the DM only group
compared to 5.3 and 1.1 years, respectively, for DM-TB subjects. For both diabetic groups, diabetes
preceded HTN, with onset of HTN occurring approximately 4 years after patients were diagnosed
diabetic. Approximately 86% of DM only subjects suffered additional comorbidity, and 44.5% had
three or more coexisting chronic diseases compared to 56% and 11.4%, respectively, in the DM-TB
group. The hospitalization period was 10.2 days for the DM-TB group compared to 7 and 4 days for
the TB only and DM only groups, respectively; however, 43% of TB only subjects needed surgical
intervention compared to 17% in the DM-TB group. The total cost wasRM4530 (US$1234.3) for the
DM-TB group compared to RM3082.8 (US$840) and RM6945.26 (US$1892.40) for the TB only and
DM only groups, respectively.
Conclusions: DM antedated HTN in our patients. Durations of both DM and HTN were longer for the
DM only group. The number of diagnosed chronic diseases and overall treatment cost was higher in
the DM-TB group compared to TB only group, but lower compared to the DM only group. The TB only
group required the most surgical intervention.