Determinants of treatment success and cost implications in MDR/RR-TB patients: a prospective cohort study in China

Multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) remains a critical global health threat. While novel regimens offer promise, the impact of socioeconomic determinants and clinical factors on treatment success is inadequately characterized, hindering targeted interventions. A prospective cohort study was conducted across 13 TB-designated hospitals in Jiangsu Province, China from 2021 to 2022. Binary logistic regression identified predictors of treatment success, with model performance assessed via Receiver Operating Characteristic (ROC) curves assessing predictive performance. The overall treatment success rate for patients with MDR/RR-TB was 67.38%, with the short-term regimen achieving a success rate of 74.4%, new long-term oral regimens at 66.7%, new long-term injectable regimens at 71.0%, traditional long-term regimens at 60.3%, though differences were not statistically significant (P = 0.454). Patients educated at the junior and senior high school levels (OR = 3.95, 95% CI: 1.70, 9.19, P = 0.001) and at the college level or above (OR = 3.13, 95% CI: 1.03, 9.51, P = 0.044) exhibited significantly higher success rates compared to those with primary school education or lower. Moreover, it underscores the irrelevance of cost to treatment outcomes. Additionally, urban workers (OR = 4.53, 95% CI: 1.22, 16.86, P = 0.024), urban residents (OR = 4.61, 95% CI: 1.25, 17.04, P = 0.022), and individuals covered by other medical insurance, including public medical insurance (OR = 8.82, 95% CI: 1.50, 51.76, P = 0.016), demonstrated higher treatment success rates compared to those without medical insurance. Conversely, hypokalemia (OR = 0.12, 95% CI: 0.02, 0.61, P = 0.010) was identified as a risk factor for successful treatment. Treatment costs demonstrated no significant association with outcomes (OR = 1.06, 95%CI: 0.96, 1.17, P = 0.284). Prioritizing health literacy programs, insurance expansion, and hypokalemia monitoring is essential for improving treatment success.