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Tuberculosis: Medical Treatments

Volume 488: debated on Monday 23 February 2009

To ask the Secretary of State for Health what proportion of tuberculosis (TB) patients received directly observed therapy in the last five years; what proportion of those had a treatment outcome of lost to follow up; and what steps NHS trusts take to encourage patients to complete the course of their treatment for TB. (256088)

The Health Protection Agency (HPA) does not collect these data. The HPA has recently redeveloped its surveillance system to collect this information about risk factors and whether patients started on treatment are under direct observation, and the new system is currently being rolled out nationally.

In 2007, the Department initiated a ‘Find and Treat’ (F&T) project to actively look for cases of tuberculosis (TB) among the homeless and other vulnerable groups in London, and to promote the use of directly observed treatment (DOT), which provides supervised medication and support to patients to improve adherence to treatment. Currently, the F&T team is helping over 300 people with TB who have challenging lifestyles to complete their treatment.

To ask the Secretary of State for Health what steps his Department is taking to prevent the spread of multi-drug resistant tuberculosis. (256089)

Prevention of the emergence and spread of any type of drug-resistant tuberculosis (TB) is being addressed through the Chief Medical Officer's (CMO) TB Action Plan. The Plan provides guidelines to primary care trusts on improving the public health surveillance system, fast and comprehensive detection of cases, rapid identification of drug resistance if it exists, and good clinical management, including measures to ensure treatment is both appropriate and completed by the patient.

National Institute for Health and Clinical Excellence (NICE) Guidelines on the Treatment and Diagnosis of TB (2006) include specific guidance on treatment and rapid contact tracing of people in contact with any type of drug resistant TB.

The key step in preventing development of drug-resistant TB is improving adherence to treatment among those TB patients who have already started their treatment.

In 2007, the Department has initiated a 'Find and Treat' project to actively look for cases of TB among the homeless and other vulnerable groups in London, and to promote the use of directly observed therapy, which provides supervised medication and support to patients to improve adherence to treatment.

To ask the Secretary of State for Health what percentage of those diagnosed with tuberculosis complete treatment; and what steps are being taken to increase treatment completion rates. (256092)

Information from the Health Protection Agency (HPA) Enhanced Tuberculosis Surveillance System shows that of the 93 per cent. of tuberculosis (TB) cases reported in 2006 in England for which the outcome is known, 79 per cent. completed treatment within 12 months of starting treatment.

The Department of Health has issued the following guidance which supports primary care trusts (PCTs) in improving treatment completion:

‘Clinical Diagnosis and Management of Tuberculosis, and Measures for its Prevention and Control’ (National Institute for Clinical Excellence (NICE), 2006); and

‘Tuberculosis Prevention and Treatment: A Toolkit for Planning, Commissioning and Delivering High-Quality Services in England’ (2007).

In 2007, the Department has initiated a ‘Find and Treat’ project to actively look for cases of TB among the homeless and other vulnerable groups in London, and to promote the use of directly observed therapy, which provides supervised medication and support to patients to improve adherence to treatment.

Currently, the Department is sponsoring an awareness campaign by TB Alert to raise awareness of TB among groups vulnerable to TB, including the importance of TB treatment completion.

To ask the Secretary of State for Health how much has been spent on treating drug-resistant tuberculosis (TB) patients in the last five years; and if he will estimate the cost of treating those patients as if they had drug-susceptible TB. (256097)

Data on the costs associated with treatment of multi-drug resistant tuberculosis (MRD-TB), either by case or in total, are not routinely collected. The National Institute for Clinical Excellence have undertaken analysis of TB treatment costs as part of the development of guidance ‘Tuberculosis—National clinical guideline for diagnosis, management, prevention, and control’.

An estimated average cost of treating one patient with MDR-TB is £60,000, compared to an £6,000 for an average case of drug-susceptible TB.

The number (and proportion) of confirmed tuberculosis cases with MDR-TB in England by year 2002-07 is as follows:

Number

Proportion (percentage)

2002

33

0.9

2003

49

1.3

2004

44

1.1

2005

40

0.9

2006

49

1.1

2007

47

1.1

Note:

The proportions are among culture confirmed cases reported to ETS that had drug susceptibility testing results for at least isoniazid and rifampicin.

Source:

Health Protection Agency Enhanced Tuberculosis Surveillance System (ETS)

To ask the Secretary of State for Health what assessment his Department has made of the threat from extensive drug resistant tuberculosis (XDR-TB) to public health; and what capacity the NHS has to treat multiple XDR-TB patients. (256104)

In the United Kingdom, less than 1 per cent. of tuberculosis (TB) cases are multi drug resistant (MDR-TB), that is, less than 50 TB cases per year. A very small proportion of the UK MDR cases might now be classed as extensive drug resistant tuberculosis (XDR-TB). The Health Protection Agency (HPA) maintains monitoring of all types of TB, and since 1993, a total of eight cases would fall into the definition of XDR-TB.

Drug-resistant TB cases need to be treated in airflow controlled isolation. In 2003, the National Audit Office carried out an audit of the national health service (NHS) isolation facilities. A total of 176 trusts were surveyed. Out of these, 63 had at least one airflow controlled room, with a total of about 300 (this figure includes paediatric facilities). It is for the NHS to determine the local level of provision of isolation facilities.