A historical budget impact and expenditure analysis of meropenem and clavulanate-based treatment for adults with XDR-TB at a specialised TB hospital in South Africa

Background: Extensively drug-resistant tuberculosis (XDR-TB) remains a major public health challenge in South Africa. Treatment options are costly and often require prolonged hospital stays. Assessing the cost of meropenem and clavulanate-based regimens can help guide resource allocation and policy. Methods: A retrospective chart analysis was conducted of adults aged 18–70 years with XDR-TB and treated with meropenem and clavulanate-based regimens between January 2018 and July 2023 at a specialised Tuberculosis (TB) hospital. Data sources included the hospital pharmacy dispensing system, National Health Laboratory Services billing records and the Electronic Drug-Resistant Tuberculosis Register. A budget impact model was developed from the payer’s perspective using Microsoft Excel. Descriptive and inferential statistics were applied to assess costs related to hospitalisation, medication and laboratory diagnostics. Results: A total of 62 patients met the inclusion criteria. The mean age was 39.5 years (95% confidence interval [CI]: 37.2–41.8), with 66.1% being male (n = 41). HIV co-infection was present in 40 patients (64.5%). The mean direct medical cost per patient for the 6-month inpatient phase was R559268.78 (≈$30 198) (95% CI: R515786.56 – R602751.00; standard deviation [s.d.]: R172653.48). Hospitalisation accounted for 87.1% of the total cost, medicines 11.9% and laboratory monitoring less than 1%, resulting in a total budget impact of R30.7 million (≈$1.66 million). Hospitalisation costs increased across the study period, and the year of initiating treatment was strongly associated with hospitalisation cost (R2 = 0.91), reflecting annual adjustments in the hospital’s patient day equivalent tariffs rather than inflation alone. Conclusion: Treatment of XDR-TB with meropenem and clavulanate-based regimens places a significant financial burden on the public health sector. Decentralised care, reduced inpatient duration and optimised procurement could reduce costs. Contribution: This study quantifies the cost of XDR-TB treatment in South Africa, highlighting hospitalisation as the main cost driver. Findings can guide improved budgeting, policy and service delivery in TB management.