Delayed Tuberculosis Treatment and Cost of Care in a Low-Incidence Country

Purpose Tuberculosis (TB) elimination requires high-quality, timely care. In countries with a low incidence of TB, such as Ireland, delayed diagnosis is common. This evaluation aimed to determine factors that predict patient-related and health care provider-related delays in TB management and to establish how TB care cost is affected by care delays. Methods Health care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1 st 2018 and December 31 st 2019 were reviewed to measure and determine predictors of patient-related delays, health care-provider related delay and the cost of TB care. Outcomes were compared against benchmarks derived from the literature. Results Thirty-seven patients were diagnosed with TB and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider-related delay among patients with PTB was 16 days and, although similar to the benchmark (median 22 days, minimum 11 days, maximum 36 days) could be improved. The health care-provider related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298, and while similar to that reported in the literature (median €9,319, minimum €6,486, maximum €14,750) could be improved. Patient-related delay among those with PTB predicted care costs. Conclusion Patient-related and health care-related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.