WHAT
This study evaluated the impact of a partial cost-exemption policy for WHO Group A/B MDR-TB drugs on treatment outcomes among 424 MDR-TB patients, with 212 favorable outcomes (79 cured, 133 completed) and 212 unfavorable outcomes, mostly driven by loss to follow-up (44.8%), followed by death (4.5%) and treatment failure (0.7%).
Drug cost-exemption emerged as the strongest predictor of treatment success, with patients receiving cost-exemption showing significantly higher odds of favorable outcomes (aOR 37.47; 95% CI 10.97–127.96; P=0.001), followed by absence of adverse reactions (aOR 11.58; 95% CI 3.81–35.18) and female sex (aOR 2.99; 95% CI 1.55–5.78).
Older age groups were associated with poorer outcomes, while treatment regimen type (all-oral vs injectable) and number of Group A drugs used were not significantly associated with treatment success.
The cost-exemption cohort analysis showed dramatically higher success rates in the exemption group (58.1%) compared with the non-exemption group (4.7%), corresponding to 28-fold higher odds of treatment success (OR 28.14; 95% CI 8.67–91.39; P<0.001).
A dose–response relationship was observed, where two-drug cost-exemption increased success 3.24-fold and three-drug cost-exemption increased success 5.13-fold, compared with one-drug exemption, indicating stronger benefits with broader financial coverage.
Stratified analyses demonstrated that cost-exemption benefits were particularly pronounced among younger patients, males, and those receiving all-oral regimens, while the effect was less consistent among females and patients receiving injectable regimens.
Cost-exemption influenced treatment regimen selection, with clinicians more likely to prescribe Group A drugs when cost barriers were removed, while no significant association was found between exemption magnitude and adverse reactions, suggesting improved outcomes were not driven by toxicity differences.
Overall, the findings indicate that economic support for key MDR-TB drugs (cycloserine, moxifloxacin, linezolid, and clofazimine) substantially improves treatment adherence and outcomes, particularly in high-burden, resource-limited settings, highlighting financial protection as a critical component of MDR-TB control strategies.
HOW
This retrospective nested case–control study was conducted among MDR-TB patients treated between January 2020 and December 2022 in four designated TB hospitals in Guangxi, China, with participants followed until treatment completion.
Eligible participants were laboratory-confirmed MDR-TB patients aged ≥14 years who initiated treatment during the study period, while those with incomplete records, severe comorbidities (e.g., HIV, malignancy), psychiatric disorders, or pregnancy were excluded.
Patients received standardized or individualized treatment regimens based on drug susceptibility testing, molecular resistance testing, prior treatment history, tolerability, and economic considerations, reflecting real-world clinical decision-making.
Treatment outcomes were categorized as favorable (cured or treatment completed) and unfavorable (death, failure, loss to follow-up, or not evaluated) following WHO definitions, and adverse reactions were defined as moderate-to-severe events requiring treatment modification or discontinuation.
Exposure of interest was partial cost-exemption for WHO Group A/B drugs, including fluoroquinolones, bedaquiline, linezolid, clofazimine, and cycloserine, and patients were further stratified by number of exempted drugs (one, two, or three).
Demographic and clinical variables collected from electronic medical records included age, sex, regimen type, number of Group A drugs, cost-exemption status, and adverse reactions, with subgroup analyses performed to evaluate differential effects.
Statistical analyses included logistic regression to identify predictors of treatment success, followed by stratified subgroup analyses to assess dose-response effects and control for potential confounding factors.
Additional cohort comparisons examined differences in medication patterns, adverse reactions, and treatment outcomes across exemption tiers, allowing evaluation of both clinical and economic impacts.
As a retrospective observational study, limitations included potential residual confounding, lack of randomization, and limited generalizability beyond Guangxi, although the nested case-control design strengthened internal validity in this real-world population.
Source: Liu, A., Liao, Y., Ye, J., Wang, Q., Huang, J., Tang, Y., & Feng, L. (2026). Effect of Drug Cost-Exemption Policy on Treatment Outcomes in Multidrug-Resistant Tuberculosis Patients in Guangxi Zhuang Autonomous Region, China: A Nested Case–Control Study. ClinicoEconomics and Outcomes Research, 577874.
