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            "entidad" => "Complejo Hospitalario Dr&#46; Negr&#237;n&#44; Las Palmas de Gran Canaria&#44; Spain"
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        "titulo" => "Costes de la tuberculosis en Espa&#241;a&#58; factores relacionados"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of cases by autonomous communities&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberculosis &#40;TB&#41; continues to be the most common global disease&#44; causing 1&#46;5 million deaths in 2014&#44; with approximately 9&#46;6 million new cases occurring every year&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> In Spain&#44; according to data from the Epidemiological Surveillance Network&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> 5018 cases of TB were notified via the individualized mandatory reporting system in 2014&#44; 3933 of which were classified as respiratory tuberculosis&#44; with an incidence rate of 10&#46;80 cases per 100&#44;000 inhabitants&#46; However&#44; a study recently conducted by the Integrated Tuberculosis Research Program &#40;PII TB&#41; of the Spanish Society of Pulmonology and Thoracic Surgery &#40;SEPAR&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a> revealed significant under-reporting&#44; ranging from 0&#37; to 40&#37; depending on the hospital&#44; with a mean under-reporting rate of 14&#46;4&#37;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The TB patient population worldwide and in Spain generates economic and social problems&#44; giving rise to direct costs in the form of healthcare spending&#44; and indirect costs&#44; primarily in the form of days of work lost&#44; and even years of life lost&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> Moreover&#44; TB affects the working population and individuals with all kinds of difficulties &#40;immigrants&#44; HIV-infected individuals&#41;&#44; so its socioeconomic impact is significant&#46; Few studies have been published in Spain on the costs of TB&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5&#8211;8</span></a> and those that have appeared are limited by their exclusive focus on hospitalization costs&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our aim&#44; then&#44; was to analyze costs derived from the diagnosis and follow-up of TB and associated factors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0020" class="elsevierStylePara elsevierViewall">Prospective observational multicenter study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Population</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with a diagnosis of TB registered in the SEPAR PII TB database between September 2014 and September 2015&#46; Nineteen hospitals participated in 9 autonomous communities&#44; and the cases were distributed according to the percentages shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Informed consent was obtained from all subjects before inclusion&#44; and the study was approved by the Regional Clinical Research Ethics Committee of the Principality of Asturias&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Inclusion Criteria</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patients were at least 18 years of age with a diagnosis of TB according to the following criteria&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Positive or negative sputum smear with <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> isolated from culture medium&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Caseifying granulomas detected in cases of extrapulmonary TB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patients with clinical&#44; radiological&#44; epidemiological and&#47;or laboratory suspicion justifying&#44; in the opinion of the physician&#44; anti-tuberculosis treatment&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">All patients attended at least 3 visits&#58; at the time of inclusion and at month 2 and 6 after starting treatment&#44; during which laboratory&#44; microbiological and radiological tests were performed and results recorded&#46; Patients who needed to prolong therapy beyond 6 months&#44; for whatever reason&#44; were scheduled to return for another visit at month 9&#44; and subsequently as judged appropriate until completion of treatment&#46; Some patients attended more than 3 visits in the first 6 months for various reasons&#44; including adverse reactions&#44; delay in bacteriological conversion&#44; suspected poor adherence&#44; etc&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Independent Variables</span><p id="par0060" class="elsevierStylePara elsevierViewall">Sociodemographic and anthropometric data were collected as well as smoking habit&#44; concomitant diseases&#44; diagnostic methods&#44; treatment&#44; drug susceptibility studies&#44; treatment adherence&#44; adverse drug reactions&#44; side effects&#44; need for hospital admission or sick leave&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Dependent Variables</span><p id="par0065" class="elsevierStylePara elsevierViewall">Direct costs &#40;hospitalization&#44; visits&#44; diagnostic tests&#44; treatment&#41; and indirect costs &#40;derived from work absenteeism and loss of productivity&#44; rehabilitation&#44; and contact tracing&#41; were estimated&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Cost Study&#46; Measures</span><p id="par0070" class="elsevierStylePara elsevierViewall">For the estimation of direct costs&#44; we considered the cost of specialist health care derived from hospitalization &#40;by day&#41;&#44; outpatient visits &#40;first and successive&#41;&#44; imaging studies &#40;standard radiography&#44; chest computed tomography &#91;CT&#93;&#41;&#44; laboratory testing &#40;complete blood count&#44; kidney and liver function tests&#41;&#44; microbiology &#40;sputum smear&#44; mycobacterial culture&#44; polymerase chain reaction &#91;PCR&#93;&#44; drug susceptibility testing&#41;&#44; and other diagnostic methods &#40;bronchoscopy&#44; pleural&#44; bronchial&#44; percutaneous&#44; transbronchial or extrathoracic biopsy&#41;&#46; Tariffs were based on the official prices for public healthcare services published by the Health Services of the Principality of Asturias<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> and the Canary Islands&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> The cost of drug treatment &#40;standard or prolonged&#41; was calculated on the basis of the maximum dose of drugs administered in a single daily dose&#44; and the use or non-use of directly observed therapy &#40;DOT&#41; was also coded&#46; Direct costs are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">All costs were compared in terms of the following variables&#58; age&#44; sex&#44; origin &#40;Spanish-born&#44; immigrant&#41;&#44; microbiological&#44; imaging and histological studies&#44; drug resistance&#44; treatment&#44; DOT&#44; and need for admission to a hospital or other healthcare facility&#44; in order to determine which variables impacted significantly on costs&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Indirect costs derived from work absenteeism and loss of productivity were estimated using the following formula&#58; number of days of sick leave&#215;cost per day of leave&#215;proportion of population in active employment&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> The assumed cost per day was &#8364;95&#46;82<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> and the employment rate in Spain&#44; retrieved from the official employment survey published by the National Institute of Statistics&#44; was taken to be 0&#46;59&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The cost of rehabilitation measures &#40;understood as treatments other than anti-tuberculosis therapy required during the course of the disease and after resolution&#41; was included&#46; These costs were considered to be incurred by 2&#46;5&#37; of patients for a mean duration of 24 days and a cost of &#8364;123&#44; with a per-patient cost of &#8364;2952&#46; Rehabilitation costs&#44; then&#44; were calculated as follows&#58; &#8364;2952&#215;0&#46;025&#61;&#8364;73&#46;8 per case&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Weighted costs incurred by contact tracing of the index case were also analyzed&#46; Based on previous statistical studies&#44; contact tracing was estimated to cost the healthcare system &#8364;921&#46;80 per patient&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Information gathered from each patient was recorded in an internet-based electronic case report form accessed via a website by each of the investigators participating in the study using a personalized user name and password&#46; Completion of the surveys and the database were monitored by telephone and electronic mail&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical Analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">The frequency distribution of variables of interest was analyzed and proportions between the groups were compared on a bivariate level using chi-squared distribution methods&#46; In the bivariate study&#44; the relationship between each of the variables and median costs &#40;categorized as binary response variable&#41; was analyzed&#46; Variables which showed significance levels of <span class="elsevierStyleItalic">P</span>&#60;&#46;05 were included in a stepwise logistical regression model&#46; Odds ratios &#40;OR&#41; and corresponding 95&#37; confidence intervals &#40;CI&#41; were calculated&#46; For all analyses&#44; significance was set at <span class="elsevierStyleItalic">P</span>&#60;&#46;05 and statistical analysis was performed using IBM SPSS Statistics 19 software&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">General Characteristics</span><p id="par0105" class="elsevierStylePara elsevierViewall">Cost data were available from 319 patients included in the study&#58; 206 men and 113 women&#44; with a mean age of 56&#46;72&#177;20&#46;79 years&#46; One hundred and three &#40;32&#46;3&#37;&#41; were immigrants and 74&#46;4&#37; presented pulmonary TB&#46; Microbiological resistance was confirmed in 14 patients &#40;4&#46;4&#37;&#41;&#58; 10 to isoniazid&#44; 2 to rifampicin&#44; and 2 to isoniazid and rifampicin &#40;MDR&#41;&#46; During the diagnostic process&#44; sputum smears were performed in 285 subjects &#40;89&#46;3&#37;&#41; &#40;56&#37; positive&#41;&#44; PCR was determined in 201 &#40;63&#37;&#41;&#44; CT in 141 &#40;44&#46;1&#37;&#41;&#44; bronchoscopy in 84 &#40;26&#46;3&#37;&#41; and biopsy in 95 &#40;30&#46;5&#37;&#41;&#58; 19 pleural&#44; 18 transbronchial&#44; 17 bronchial&#44; 10 percutaneous&#44; and 31 in other sites&#46; Treatment regimens of 6 months were administered&#44; with 4 drugs in 70&#46;5&#37; of cases and with 3 drugs in 20&#46;7&#37;&#46; Cure or completion of treatment was achieved in 89&#46;1&#37;&#46; DOT was performed in 67 patients &#40;21&#37;&#41;&#46; A total of 187 patients &#40;58&#46;6&#37;&#41; were admitted to hospital for a mean duration of 11&#46;3&#177;7&#46;09 days and 44 &#40;13&#46;8&#37;&#41; to other healthcare facilities for a mean duration of 31&#177;90&#46;65 days&#46; The mean number of outpatient visits was 6&#46;81&#177;3&#46;62&#46; In total&#44; 133 patients &#40;41&#46;7&#37;&#41; were in active employment and 89 &#40;27&#46;9&#37;&#41; needed to take sick leave lasting on average 21&#46;74&#177;55 days at some time during the course of treatment&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Cost Study</span><p id="par0110" class="elsevierStylePara elsevierViewall">Total cost was &#8364;3&#44;188&#44;477&#46;39&#58; &#8364;2&#44;763&#44;954&#46;10 for direct costs and &#8364;424&#44;523&#46;29 for indirect costs &#40;&#8364;106&#44;926&#46;89 due to loss of productivity&#44; &#8364;294&#44;054&#46;20 for contact studies&#44; and &#8364;23&#44;542&#46;20 for rehabilitation&#41;&#44; with a mean cost per patient of &#8364;10&#44;262&#46;62&#177;&#8364;14&#44;961&#46;66&#46; Direct costs were distributed as follows&#58; 61&#46;4&#37; derived from admission to hospitals and other healthcare facilities&#44; 17&#46;6&#37; from treatment &#40;including DOT&#41;&#44; 13&#46;4&#37; from diagnostic studies &#40;microbiological and histological&#41;&#44; 5&#46;2&#37; from outpatient visits and laboratory tests&#44; and 1&#46;8&#37; from imaging techniques&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; the bivariate analysis revealed that costs were associated with male sex&#44; admission to a hospital or other healthcare facility&#44; PCR&#44; antibiotic resistance testing&#44; chest CT&#44; pleural biopsy&#44; drug treatment lasting more than 9 months&#44; DOT&#44; and sick leave&#46; The multivariate study showed an independent association between costs and the following variables&#58; hospitalization &#40;OR&#61;96&#46;8&#58; CI&#58; 29&#8211;472&#46;3&#41;&#44; drug susceptibility testing &#40;OR&#61;4&#46;34&#59; CI&#58; 1&#46;71&#8211;12&#46;1&#41;&#44; chest CT &#40;OR&#61;2&#46;25&#59; CI&#58; 1&#46;08&#8211;4&#46;77&#41;&#44; DOT &#40;OR&#61;20&#46;76&#59; CI&#58; 4&#46;11&#8211;148&#41; and sick leave &#40;OR&#61;26&#46;9&#59; CI&#58; 8&#46;51&#8211;122&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Several original articles have been published in recent years on the costs generated by various aspects of tuberculosis&#44; showing how the distribution of costs varies depending on the economic resources of the country in question&#46; The fewer the resources&#44; the greater the spending derived from indirect costs in the post-diagnosis period&#44; while in more highly developed regions&#44; direct costs&#44; in particular those generated by hospitalization&#44; have the most impact&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">A recent study of all series published in the European Union&#44; of which only 1 was conducted in Spain&#44; showed that mean per-patient cost of drug-sensitive tuberculosis was &#8364;10&#44;282 and &#8364;57&#44;213 for MDR&#44; 77&#37; of which was derived from direct costs&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> In our study&#44; which had a similar design&#44; the percentage of expenditure attributed to direct costs was 86&#37;&#44; and mean cost per patient was lower&#44; perhaps due to the small percentage of cases with resistance&#44; including MDR&#46; This is in line with previous studies in Spain that reported an overall rate of 9&#46;2&#37; for drug resistance and 1&#46;9&#37; for MDR&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> The lower impact of indirect costs may derive from our use of an employment rate of 59&#37;&#44; retrieved from the official employment survey data&#44; for the calculation of costs derived from loss of productivity&#44; in contrast to the 71&#37; employment rate reported in the aforementioned series&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> Basing our calculations on a rate of 71&#37; would have increased indirect costs by approximately 16&#37;&#44; which would give us a result more in line with that obtained in the European study&#46; Nevertheless&#44; that study showed striking variations among our neighboring countries&#44; with mean costs ranging from &#8364;5691 to &#8364;8242 per patient&#46; These differences were supported by a study performed in Denmark where the mean direct cost of TB was &#8364;10&#44;509&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> In this country&#44; as in Spain&#44; the resistance rate is low&#44; and therefore the results of the Danish authors are similar to ours&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In our series&#44; costs were determined by hospitalization &#40;accounting for 61&#37; of total expenditure&#41;&#44; drug susceptibility testing&#44; DOT&#44; sick leave&#44; and chest CT&#46; The impact of hospital costs has already been addressed by Montes-Santiago et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> who observed that in Spain in 2006&#44; the cost of hospitalization for tuberculosis amounted to &#8364;30&#46;8 million&#46; Assuming that hospitalization accounts for 70&#37; of costs&#44; the total cost of tuberculosis was &#8364;40 million&#44; representing 0&#46;7&#37; of total public expenditure&#46; These authors also observed a slight fall in costs coinciding with fewer hospital admissions between 1999 and 2006&#46; Similarly&#44; in another series conducted in Germany&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> the cost of a hospital stay was practically 9 times that of treating the patient on an exclusively outpatient basis&#46; The same occurred in Denmark&#44; where hospitalization accounts for 81&#37; of costs&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> Furthermore&#44; in a national tuberculosis program in South Africa&#44; Pooran et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a> determined that costs generated by hospitalization accounted for a significant portion of total costs&#58; 56&#37; in their case&#46; Considering the above&#44; hospital admission for TB should be avoided as far as possible and limited to cases recommended in clinical guidelines<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> &#40;severe cases or disease complications and impossibility to isolate the patient at home&#41;&#44; in order to reduce the risk of transmission and disease-related costs&#46; Nonetheless&#44; the percentage of hospital admissions for tuberculosis remains high&#44; both in our sample&#44; where it was 59&#37;&#44; and in other national and international reports&#44; which range from 52&#37; to 78&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">7&#44;8&#44;11&#44;20&#44;21</span></a> although the reason for this high proportion remains unclear&#46; Thus&#44; a strategy aimed at reducing hospital stays would reduce costs&#44; as has already been observed in some regions which have managed to achieve rates as low as 34&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> If we take this figure and extrapolate our results to the number of TB cases notified in Spain in 2014&#44; we estimate that savings of &#8364;14 million could be achieved&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Steffen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> found that costs of DOT were significantly higher than the cost of self-administered treatment&#44; but that it increased&#44; albeit insignificantly&#44; the rate of treatment completion&#46; Furthermore&#44; a recent meta-analysis of studies performed mainly in south-east Asia and English-speaking countries showed that DOT does not improve outcomes in terms of microbiological cure&#44; prevention of relapse or development of acquired resistance compared to self-administered medication&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> so it seems reasonable to limit the use of DOT in countries with low to medium incidence to populations in special situations&#46; In our setting&#44; it is reserved solely for complicated cases or individuals with severe social problems who cannot follow their regimen normally&#46; DOT is currently used in less than 25&#37; of patients&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Our results also suggest that expenditure can also be reduced by decreasing the duration of sick leave&#44; since earlier studies have shown that it has a significant impact on costs&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> We must bear in mind that the main objective is to reduce the transmission of the disease and that&#44; with standard treatment&#44; contagiousness is significantly reduced after 3 weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> After that time&#44; isolation measures can be lifted and the subject can return to the workplace&#46; This period coincides with the mean number of days of sick leave identified in our study&#44; so we can surmise that this aspect is not one of the most important in our setting&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">From all of the above&#44; then&#44; we can conclude that avoiding unnecessary hospital stays is the only way to reduce costs&#46; Nevertheless&#44; it is important to point out that&#44; since TB gives rise to significant healthcare costs &#40;extrapolating the data from our study to cases notified in 2015&#44; expenditure would amount to &#8364;51&#44;500&#44;000&#41;&#44; reducing the number of cases is the surest way to reduce costs&#46; This&#44; in turn&#44; highlights the importance of such proven cost-effective strategies as contact tracing and treatment of latent tuberculous infection&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Our study is limited in several ways&#46; Similarly to the studies discussed above&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12&#44;13</span></a> we have only included estimated indirect costs derived from loss of productivity&#44; rehabilitation therapies&#44; and contact tracing&#44; and have probably underestimated the real costs by failing to include other indirect costs&#44; such as transport&#44; food&#44; electricity&#44; maintenance&#44; and human resources incurred by personnel caring for these patients&#44; and the costs of primary care&#46; However&#44; many of these costs would have greater impact in countries lacking in resources and universal healthcare provision&#44; or in populations with a significant proportion of patients with special requirements &#40;which does not seem to be the case in our series&#41;&#46; Moreover&#44; the diagnosis and follow-up of these patients is generally performed in specialized care&#46; We also did not include costs derived from pharmacological side effects&#44; since most of them are reversible after discontinuation of the causative drug&#44; and do not require further measures&#46; The cost of adjuvant medication for gastrointestinal side effects is negligible&#46; We therefore believe that&#44; while it may be interesting to include these costs&#44; they would not significantly affect the final outcomes of our study&#44; and excluding them does not affect the validity of our conclusions&#46; Finally&#44; we used costing data from only 2 health services in our calculations&#44; so we are aware that due to the variations between the different autonomous communities and the fact that only 9 of these participated in the study&#44; our study may not reflect the exact cost of tuberculosis&#46; However&#44; we would like to point out that we aimed to use our data to obtain an approximate estimation&#44; and we believe that we have achieved this in a reasonable enough manner for our study to have meaning in this setting&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">Tuberculosis gives rise to significant healthcare costs&#44; generated by hospitalizations&#44; imaging studies&#44; directly observed treatment and the need for sick leave&#46; Hospital admission appears to be the factor with the most impact&#44; so strategies aimed at decreasing hospital stays would be essential if costs have to be reduced&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">This project was funded by <span class="elsevierStyleGrantSponsor" id="gs1">SEPAR</span> grant <span class="elsevierStyleGrantNumber" refid="gs1">136&#47;2013</span>&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Authorship</span><p id="par0165" class="elsevierStylePara elsevierViewall">Jos&#233; Antonio Gull&#243;n&#58; study concept&#46; Writing&#44; critical reading&#44; review and final approval of the manuscript&#46; Analysis of results&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Jos&#233; Mar&#237;a Garc&#237;a&#58; study concept&#46; Critical reading&#44; review and final approval of the manuscript&#46; Analysis of results&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Manuel &#193;ngel Villanueva and Fernando &#193;lvarez-Navascues&#58; study concept&#46; Analysis of results&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Teresa Rodrigo and Joan Cayl&#225;&#58; critical reading&#44; review and final approval of the manuscript&#46; Analysis of results&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Mart&#237; Casals&#58; statistical analysis&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Marta Garc&#237;a-Clemente&#44; Luis Anibarro&#44; Mar&#237;a &#193;ngeles Jim&#233;nez&#44; Ana Bustamante&#44; Ant&#243;n Penas and Jos&#233; Antonio Caminero&#58; critical reading&#44; review and final approval of the manuscript&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">PII TB Working Group&#58; data collection&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflict of Interests</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Objective"
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              "titulo" => "Patients and methods"
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              "titulo" => "Results"
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              "identificador" => "abst0020"
              "titulo" => "Conclusion"
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        1 => array:2 [
          "identificador" => "xpalclavsec764354"
          "titulo" => "Keywords"
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          "titulo" => "Resumen"
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              "identificador" => "abst0030"
              "titulo" => "Pacientes y m&#233;todos"
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            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
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            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusi&#243;n"
            ]
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        ]
        3 => array:2 [
          "identificador" => "xpalclavsec764353"
          "titulo" => "Palabras clave"
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          "identificador" => "sec0005"
          "titulo" => "Introduction"
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          "titulo" => "Patients and Methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Design"
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              "identificador" => "sec0020"
              "titulo" => "Population"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Inclusion Criteria"
            ]
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              "identificador" => "sec0030"
              "titulo" => "Variables"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0035"
                  "titulo" => "Independent Variables"
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                1 => array:2 [
                  "identificador" => "sec0040"
                  "titulo" => "Dependent Variables"
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              "identificador" => "sec0045"
              "titulo" => "Cost Study&#46; Measures"
            ]
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              "identificador" => "sec0050"
              "titulo" => "Statistical Analysis"
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          ]
        ]
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          "identificador" => "sec0055"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "General Characteristics"
            ]
            1 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Cost Study"
            ]
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          "titulo" => "Discussion"
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          "titulo" => "Conclusions"
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          "titulo" => "Funding"
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          "titulo" => "Authorship"
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          "identificador" => "sec0090"
          "titulo" => "Conflict of Interests"
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        12 => array:1 [
          "titulo" => "References"
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-03-05"
    "fechaAceptado" => "2016-05-02"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec764354"
          "palabras" => array:3 [
            0 => "Tuberculosis"
            1 => "Hospital income"
            2 => "Cost analysis"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec764353"
          "palabras" => array:3 [
            0 => "Tuberculosis"
            1 => "Ingreso hospitalario"
            2 => "Costes"
          ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the direct and indirect costs of diagnosis and management of tuberculosis &#40;TB&#41; and associated factors&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospective study of patients diagnosed with TB between September 2014 and September 2015&#46; We calculated direct &#40;hospital stays&#44; visits&#44; diagnostic tests&#44; and treatment&#41; and indirect &#40;sick leave and loss of productivity&#44; contact tracing&#44; and rehabilitation&#41; costs&#46; The following cost-related variables were compared&#58; age&#44; gender&#44; country of origin&#44; hospital stays&#44; diagnostic testing&#44; sensitivity testing&#44; treatment&#44; resistance&#44; directed observed therapy &#40;DOT&#41;&#44; and days of sick leave&#46; Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio &#40;OR&#41; and corresponding 95&#37; confidence intervals&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">319 patients were included with a mean age of 56&#46;72&#177;20&#46;79 years&#46; The average cost was &#8364;10&#44;262&#46;62&#177;14&#44;961&#46;66&#44; which increased significantly when associated with hospital admission&#44; polymerase chain reaction&#44; sputum smears and cultures&#44; sensitivity testing&#44; chest computed tomography&#44; pleural biopsy&#44; drug treatment longer than nine months&#44; DOT and sick leave&#46; In the multivariate analysis&#44; hospitalization &#40;OR&#61;96&#46;8&#59; CI 29&#8211;472&#41;&#44; sensitivity testing &#40;OR&#61;4&#46;34&#59; CI 1&#46;71&#8211;12&#46;1&#41;&#44; chest CT &#40;OR&#61;2&#46;25&#59; CI 1&#46;08&#8211;4&#46;77&#41;&#44; DOT &#40;OR&#61;20&#46;76&#59; CI 4&#46;11&#8211;148&#41; and sick leave &#40;OR&#61;26&#46;9&#59; CI 8&#46;51&#8211;122&#41; showed an independent association with cost&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Tuberculosis gives rise to significant health spending&#46; In order to reduce these costs&#44; more control of transmission&#44; and fewer hospital admissions would be required&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar los costes directos e indirectos derivados del diagn&#243;stico y tratamiento de la tuberculosis &#40;TB&#41; y sus factores asociados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de pacientes diagnosticados de TB entre septiembre de 2014 y septiembre de 2015&#46; Se calcularon los costes directos &#40;estancias hospitalarias&#44; consultas&#44; estudios diagn&#243;sticos y tratamiento&#41;&#44; e indirectos &#40;absentismo laboral y p&#233;rdida de productividad&#44; estudio de contactos y medidas rehabilitadoras&#41;&#46; Los costes se compararon atendiendo a las variables&#58; edad&#44; sexo&#44; pa&#237;s de origen&#44; ingreso hospitalario&#44; pruebas diagn&#243;sticas&#44; tratamiento&#44; resistencia farmacol&#243;gica&#44; tratamiento directamente observado &#40;TDO&#41; y d&#237;as de baja laboral&#46; Se compararon proporciones mediante Chi cuadrado y las variables significativas se incluyeron en un modelo de regresi&#243;n log&#237;stica calcul&#225;ndose las <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; y sus correspondientes intervalos de confianza del 95&#37; &#40;IC&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fueron incluidos 319 pacientes con una edad media de 56&#44;72&#177;20&#44;79 a&#241;os&#46; El coste medio fue de 10&#46;262&#44;62&#177;14&#46;961&#44;66<span class="elsevierStyleHsp" style=""></span>&#8364;&#44; y aumentaba significativamente en relaci&#243;n con el ingreso hospitalario&#44; el uso de la PCR&#44; la realizaci&#243;n de baciloscopia y cultivo&#44; antibiograma&#44; tomograf&#237;a axial computarizada de t&#243;rax&#44; biopsia pleural&#44; tratamiento de m&#225;s de 9 meses&#44; TDO y baja laboral&#46; En el an&#225;lisis multivariante manten&#237;an asociaci&#243;n independiente&#58; ingreso hospitalario &#40;OR&#61;96&#44;8&#59; IC&#58; 29-472&#44;3&#41;&#44; antibiograma &#40;OR&#61;4&#44;34&#59; IC&#58; 1&#44;71-12&#44;1&#41;&#44; tomograf&#237;a axial computarizada de t&#243;rax &#40;OR&#61;2&#44;25&#59; IC&#58; 1&#44;08-4&#44;77&#41;&#44; TDO &#40;OR&#61;20&#44;76&#59; IC&#58; 4&#44;11-148&#41; y baja laboral &#40;OR&#61;26&#44;9&#59; IC&#58; 8&#44;51-122&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La Tuberculosis acarrea un gasto sanitario significativo&#46; Medidas dirigidas a mejorar el control de la enfermedad y disminuir los ingresos hospitalarios ser&#237;an importantes para reducirlo&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Resultados"
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            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
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    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gull&#243;n JA&#44; Garc&#237;a-Garc&#237;a JM&#44; Villanueva M&#193;&#44; &#193;lvarez-Navascues F&#44; Rodrigo T&#44; Casals M&#44; et al&#46; Costes de la tuberculosis en Espa&#241;a&#58; factores relacionados&#46; Arch Bronconeumol&#46; 2016&#59;52&#58;583&#8211;589&#46;</p>"
      ]
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Members of the Integrated Tuberculosis Research Program &#40;PIITB&#41; Working Group are listed in <a class="elsevierStyleCrossRef" href="#sec0095">Annex</a>&#46;</p>"
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      ]
    ]
    "apendice" => array:1 [
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          0 => array:4 [
            "apendice" => "<p id="par0205" class="elsevierStylePara elsevierViewall">N&#46; Altet &#40;Serveis Clinics&#44; Barcelona&#41;&#59; E&#46; Biku&#241;a &#40;Hospital de Zum&#225;rraga&#44; Zum&#225;rraga&#41;&#59; E&#46; Carri&#243; &#40;Centro Asistencial Dr&#46; Emili Mira i L&#243;pez&#41;&#59; X&#46; Casas &#40;Hospital de Sant Boi&#44; Llobregat&#41;&#59; F&#46;J&#46; Garros &#40;Hospital Santa Marina&#44; Bilbao&#41;&#59; M&#46; Jim&#233;nez &#40;Hospital Universitario de Donostia&#44; Donostia&#41;&#59; I&#46; L&#243;pez &#40;Hospital Universitario de Cruces&#44; Barakaldo&#41;&#59; M&#46; Mar&#237;n &#40;Hospital General de Castell&#243;n&#44; Castell&#243;n&#41;&#59; J&#46;F&#46; Medina &#40;Hospital Universitario Virgen del Roc&#237;o&#44; Sevilla&#41;&#59; J&#46;P&#46; Millet &#40;Serveis Clinics&#44; Barcelona&#41;&#59; I&#46; Mir &#40;Hospital Son Llatzer&#44; Palma de Mallorca&#41;&#59; Laura Rodr&#237;guez &#40;Hospital Universitario Germans Tr&#237;as i Pujol&#44; Badalona&#41;&#59; F&#46; S&#225;nchez &#40;Hospital del Mar&#44; Barcelona&#41;&#46;</p>"
            "etiqueta" => "Annex"
            "titulo" => "Tuberculosis Research Integrated Program Working Group &#40;PIITB&#41;"
            "identificador" => "sec0095"
          ]
        ]
      ]
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">MDR&#58; resistance to rifampicin and isoniazid&#59; CT&#58; computed tomography&#59; DOT&#58; directly observed treatment&#59; PCR&#58; polymerase chain reaction&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hospital stay&#47;day</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">403&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Stay in other healthcare facility&#47;day</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">126&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Visit</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>First&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">120&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Successive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Laboratory tests &#40;complete blood count&#44; liver function&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mycobacteria &#40;sputum smear and culture&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Drug susceptibility testing</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">PCR</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#46;65&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">202&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Bronchoscopy and bronchial aspiration</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">151&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Bronchoscopy with biopsy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">215&#46;46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CT-guided percutaneous biopsy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">266&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Extrathoracic biopsy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Treatment</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6 months</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>3 drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">224&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>4 drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">206&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>9 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Isoniazid resistance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">517&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rifampicin resistance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2079&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MDR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7834&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">DOT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">SS and culture&#58; sputum smear and mycobacterial culture&#59; OR&#58; odds ratio&#59; PCR&#58; polymerase chain reaction&#59; Ref&#46;&#58; reference&#59; CT&#58; computed tomography&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Median Cost</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Bivariate Analysis</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate Analysis</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">&#60;&#8364;4573&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">&#8805;&#8364;4573&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;60&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;39&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;43&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112 &#40;56&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;02 &#40;1&#46;25&#8211;3&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;20 &#40;0&#46;99&#8211;5&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>18&#8211;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;50&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;49&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>31&#8211;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;03 &#40;0&#46;58&#8211;1&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;48&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;51&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;09 &#40;0&#46;60&#8211;1&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Country of origin</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Spanish-born&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;53&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101 &#40;46&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Immigrant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;42&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;57&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;52 &#40;0&#46;95&#8211;2&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Hospital admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111 &#40;84&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;15&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139 &#40;74&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;1 &#40;8&#46;66&#8211;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&#46;8 &#40;29&#8211;472&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Other healthcare facility</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">158 &#40;57&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117 &#40;42&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;97&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;6 &#40;10&#46;9&#8211;119&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;29 &#40;0&#46;67&#8211;8&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">PCR</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;65&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;34&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82 &#40;40&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119 &#40;50&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;71 &#40;1&#46;70&#8211;4&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;06 &#40;1&#46;09&#8211;11&#46;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">SS and culture</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;73&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;26&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">151 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;09 &#40;1&#46;43&#8211;7&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Drug susceptibilty testing</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;70&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;29&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;42&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135 &#40;57&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;16 &#40;1&#46;87&#8211;5&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;34 &#40;1&#46;71&#8211;12&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Resistance</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">153 &#40;50&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152 &#40;49&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;42&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;13 &#40;0&#46;44&#8211;4&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Chest CT</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104 &#40;58&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;41&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;19 &#40;1&#46;40&#8211;3&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;25 &#40;1&#46;08&#8211;4&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Pleural biopsy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155 &#40;51&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">145 &#40;48&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;78&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;89 &#40;1&#46;36&#8211;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;70 &#40;0&#46;95&#8211;28&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Bronchoscopy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;54&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;45&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;48&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122 &#40;51&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;31 &#40;0&#46;79&#8211;2&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">121 &#40;53&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104 &#40;46&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>9 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;31 &#40;0&#46;76&#8211;2&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prolonged&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;43 &#40;1&#46;45&#8211;9&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;26 &#40;0&#46;95&#8211;8&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">DOT</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">154 &#40;61&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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Original Article
Tuberculosis Costs in Spain and Related Factors
Costes de la tuberculosis en España: factores relacionados
José Antonio Gullóna,d,
Corresponding author
josegubl@gmail.com

Corresponding author.
, José María García-Garcíaa,d, Manuel Ángel Villanuevaa, Fernando Álvarez-Navascuesa, Teresa Rodrigob,d,e, Martí Casalsd,e, Luis Anibarrod,f, Marta María García-Clemented,g, María Ángeles Jiménezd,h, Ana Bustamanted,i, Antón Penasd,j, José Antonio Caminerod,k, Joan Caylàc,d, Tuberculosis Research Integrated Program Working Group (PIITB) 1
a Unidad de Gestión Clínica, Neumología, Hospital San Agustín, Avilés, Asturias, Spain
b Fundación Respira, Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
c Agencia de Salud Pública de Barcelona, Barcelona, Spain
d Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, Barcelona, Spain
e CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
f Hospital Universitario de Pontevedra, Pontevedra, Spain
g Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
h Hospital Universitario Val D’Hebrón, Barcelona, Spain
i Hospital Sierrallana, Torrelavega, Cantabria, Spain
j Hospital Universitario Lucus Augusti, Lugo, Spain
k Complejo Hospitalario Dr. Negrín, Las Palmas de Gran Canaria, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberculosis &#40;TB&#41; continues to be the most common global disease&#44; causing 1&#46;5 million deaths in 2014&#44; with approximately 9&#46;6 million new cases occurring every year&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> In Spain&#44; according to data from the Epidemiological Surveillance Network&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> 5018 cases of TB were notified via the individualized mandatory reporting system in 2014&#44; 3933 of which were classified as respiratory tuberculosis&#44; with an incidence rate of 10&#46;80 cases per 100&#44;000 inhabitants&#46; However&#44; a study recently conducted by the Integrated Tuberculosis Research Program &#40;PII TB&#41; of the Spanish Society of Pulmonology and Thoracic Surgery &#40;SEPAR&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a> revealed significant under-reporting&#44; ranging from 0&#37; to 40&#37; depending on the hospital&#44; with a mean under-reporting rate of 14&#46;4&#37;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The TB patient population worldwide and in Spain generates economic and social problems&#44; giving rise to direct costs in the form of healthcare spending&#44; and indirect costs&#44; primarily in the form of days of work lost&#44; and even years of life lost&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> Moreover&#44; TB affects the working population and individuals with all kinds of difficulties &#40;immigrants&#44; HIV-infected individuals&#41;&#44; so its socioeconomic impact is significant&#46; Few studies have been published in Spain on the costs of TB&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5&#8211;8</span></a> and those that have appeared are limited by their exclusive focus on hospitalization costs&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our aim&#44; then&#44; was to analyze costs derived from the diagnosis and follow-up of TB and associated factors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0020" class="elsevierStylePara elsevierViewall">Prospective observational multicenter study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Population</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with a diagnosis of TB registered in the SEPAR PII TB database between September 2014 and September 2015&#46; Nineteen hospitals participated in 9 autonomous communities&#44; and the cases were distributed according to the percentages shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Informed consent was obtained from all subjects before inclusion&#44; and the study was approved by the Regional Clinical Research Ethics Committee of the Principality of Asturias&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Inclusion Criteria</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patients were at least 18 years of age with a diagnosis of TB according to the following criteria&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Positive or negative sputum smear with <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> isolated from culture medium&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Caseifying granulomas detected in cases of extrapulmonary TB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patients with clinical&#44; radiological&#44; epidemiological and&#47;or laboratory suspicion justifying&#44; in the opinion of the physician&#44; anti-tuberculosis treatment&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">All patients attended at least 3 visits&#58; at the time of inclusion and at month 2 and 6 after starting treatment&#44; during which laboratory&#44; microbiological and radiological tests were performed and results recorded&#46; Patients who needed to prolong therapy beyond 6 months&#44; for whatever reason&#44; were scheduled to return for another visit at month 9&#44; and subsequently as judged appropriate until completion of treatment&#46; Some patients attended more than 3 visits in the first 6 months for various reasons&#44; including adverse reactions&#44; delay in bacteriological conversion&#44; suspected poor adherence&#44; etc&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Independent Variables</span><p id="par0060" class="elsevierStylePara elsevierViewall">Sociodemographic and anthropometric data were collected as well as smoking habit&#44; concomitant diseases&#44; diagnostic methods&#44; treatment&#44; drug susceptibility studies&#44; treatment adherence&#44; adverse drug reactions&#44; side effects&#44; need for hospital admission or sick leave&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Dependent Variables</span><p id="par0065" class="elsevierStylePara elsevierViewall">Direct costs &#40;hospitalization&#44; visits&#44; diagnostic tests&#44; treatment&#41; and indirect costs &#40;derived from work absenteeism and loss of productivity&#44; rehabilitation&#44; and contact tracing&#41; were estimated&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Cost Study&#46; Measures</span><p id="par0070" class="elsevierStylePara elsevierViewall">For the estimation of direct costs&#44; we considered the cost of specialist health care derived from hospitalization &#40;by day&#41;&#44; outpatient visits &#40;first and successive&#41;&#44; imaging studies &#40;standard radiography&#44; chest computed tomography &#91;CT&#93;&#41;&#44; laboratory testing &#40;complete blood count&#44; kidney and liver function tests&#41;&#44; microbiology &#40;sputum smear&#44; mycobacterial culture&#44; polymerase chain reaction &#91;PCR&#93;&#44; drug susceptibility testing&#41;&#44; and other diagnostic methods &#40;bronchoscopy&#44; pleural&#44; bronchial&#44; percutaneous&#44; transbronchial or extrathoracic biopsy&#41;&#46; Tariffs were based on the official prices for public healthcare services published by the Health Services of the Principality of Asturias<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> and the Canary Islands&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> The cost of drug treatment &#40;standard or prolonged&#41; was calculated on the basis of the maximum dose of drugs administered in a single daily dose&#44; and the use or non-use of directly observed therapy &#40;DOT&#41; was also coded&#46; Direct costs are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">All costs were compared in terms of the following variables&#58; age&#44; sex&#44; origin &#40;Spanish-born&#44; immigrant&#41;&#44; microbiological&#44; imaging and histological studies&#44; drug resistance&#44; treatment&#44; DOT&#44; and need for admission to a hospital or other healthcare facility&#44; in order to determine which variables impacted significantly on costs&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Indirect costs derived from work absenteeism and loss of productivity were estimated using the following formula&#58; number of days of sick leave&#215;cost per day of leave&#215;proportion of population in active employment&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> The assumed cost per day was &#8364;95&#46;82<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> and the employment rate in Spain&#44; retrieved from the official employment survey published by the National Institute of Statistics&#44; was taken to be 0&#46;59&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The cost of rehabilitation measures &#40;understood as treatments other than anti-tuberculosis therapy required during the course of the disease and after resolution&#41; was included&#46; These costs were considered to be incurred by 2&#46;5&#37; of patients for a mean duration of 24 days and a cost of &#8364;123&#44; with a per-patient cost of &#8364;2952&#46; Rehabilitation costs&#44; then&#44; were calculated as follows&#58; &#8364;2952&#215;0&#46;025&#61;&#8364;73&#46;8 per case&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Weighted costs incurred by contact tracing of the index case were also analyzed&#46; Based on previous statistical studies&#44; contact tracing was estimated to cost the healthcare system &#8364;921&#46;80 per patient&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Information gathered from each patient was recorded in an internet-based electronic case report form accessed via a website by each of the investigators participating in the study using a personalized user name and password&#46; Completion of the surveys and the database were monitored by telephone and electronic mail&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical Analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">The frequency distribution of variables of interest was analyzed and proportions between the groups were compared on a bivariate level using chi-squared distribution methods&#46; In the bivariate study&#44; the relationship between each of the variables and median costs &#40;categorized as binary response variable&#41; was analyzed&#46; Variables which showed significance levels of <span class="elsevierStyleItalic">P</span>&#60;&#46;05 were included in a stepwise logistical regression model&#46; Odds ratios &#40;OR&#41; and corresponding 95&#37; confidence intervals &#40;CI&#41; were calculated&#46; For all analyses&#44; significance was set at <span class="elsevierStyleItalic">P</span>&#60;&#46;05 and statistical analysis was performed using IBM SPSS Statistics 19 software&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">General Characteristics</span><p id="par0105" class="elsevierStylePara elsevierViewall">Cost data were available from 319 patients included in the study&#58; 206 men and 113 women&#44; with a mean age of 56&#46;72&#177;20&#46;79 years&#46; One hundred and three &#40;32&#46;3&#37;&#41; were immigrants and 74&#46;4&#37; presented pulmonary TB&#46; Microbiological resistance was confirmed in 14 patients &#40;4&#46;4&#37;&#41;&#58; 10 to isoniazid&#44; 2 to rifampicin&#44; and 2 to isoniazid and rifampicin &#40;MDR&#41;&#46; During the diagnostic process&#44; sputum smears were performed in 285 subjects &#40;89&#46;3&#37;&#41; &#40;56&#37; positive&#41;&#44; PCR was determined in 201 &#40;63&#37;&#41;&#44; CT in 141 &#40;44&#46;1&#37;&#41;&#44; bronchoscopy in 84 &#40;26&#46;3&#37;&#41; and biopsy in 95 &#40;30&#46;5&#37;&#41;&#58; 19 pleural&#44; 18 transbronchial&#44; 17 bronchial&#44; 10 percutaneous&#44; and 31 in other sites&#46; Treatment regimens of 6 months were administered&#44; with 4 drugs in 70&#46;5&#37; of cases and with 3 drugs in 20&#46;7&#37;&#46; Cure or completion of treatment was achieved in 89&#46;1&#37;&#46; DOT was performed in 67 patients &#40;21&#37;&#41;&#46; A total of 187 patients &#40;58&#46;6&#37;&#41; were admitted to hospital for a mean duration of 11&#46;3&#177;7&#46;09 days and 44 &#40;13&#46;8&#37;&#41; to other healthcare facilities for a mean duration of 31&#177;90&#46;65 days&#46; The mean number of outpatient visits was 6&#46;81&#177;3&#46;62&#46; In total&#44; 133 patients &#40;41&#46;7&#37;&#41; were in active employment and 89 &#40;27&#46;9&#37;&#41; needed to take sick leave lasting on average 21&#46;74&#177;55 days at some time during the course of treatment&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Cost Study</span><p id="par0110" class="elsevierStylePara elsevierViewall">Total cost was &#8364;3&#44;188&#44;477&#46;39&#58; &#8364;2&#44;763&#44;954&#46;10 for direct costs and &#8364;424&#44;523&#46;29 for indirect costs &#40;&#8364;106&#44;926&#46;89 due to loss of productivity&#44; &#8364;294&#44;054&#46;20 for contact studies&#44; and &#8364;23&#44;542&#46;20 for rehabilitation&#41;&#44; with a mean cost per patient of &#8364;10&#44;262&#46;62&#177;&#8364;14&#44;961&#46;66&#46; Direct costs were distributed as follows&#58; 61&#46;4&#37; derived from admission to hospitals and other healthcare facilities&#44; 17&#46;6&#37; from treatment &#40;including DOT&#41;&#44; 13&#46;4&#37; from diagnostic studies &#40;microbiological and histological&#41;&#44; 5&#46;2&#37; from outpatient visits and laboratory tests&#44; and 1&#46;8&#37; from imaging techniques&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; the bivariate analysis revealed that costs were associated with male sex&#44; admission to a hospital or other healthcare facility&#44; PCR&#44; antibiotic resistance testing&#44; chest CT&#44; pleural biopsy&#44; drug treatment lasting more than 9 months&#44; DOT&#44; and sick leave&#46; The multivariate study showed an independent association between costs and the following variables&#58; hospitalization &#40;OR&#61;96&#46;8&#58; CI&#58; 29&#8211;472&#46;3&#41;&#44; drug susceptibility testing &#40;OR&#61;4&#46;34&#59; CI&#58; 1&#46;71&#8211;12&#46;1&#41;&#44; chest CT &#40;OR&#61;2&#46;25&#59; CI&#58; 1&#46;08&#8211;4&#46;77&#41;&#44; DOT &#40;OR&#61;20&#46;76&#59; CI&#58; 4&#46;11&#8211;148&#41; and sick leave &#40;OR&#61;26&#46;9&#59; CI&#58; 8&#46;51&#8211;122&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Several original articles have been published in recent years on the costs generated by various aspects of tuberculosis&#44; showing how the distribution of costs varies depending on the economic resources of the country in question&#46; The fewer the resources&#44; the greater the spending derived from indirect costs in the post-diagnosis period&#44; while in more highly developed regions&#44; direct costs&#44; in particular those generated by hospitalization&#44; have the most impact&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">A recent study of all series published in the European Union&#44; of which only 1 was conducted in Spain&#44; showed that mean per-patient cost of drug-sensitive tuberculosis was &#8364;10&#44;282 and &#8364;57&#44;213 for MDR&#44; 77&#37; of which was derived from direct costs&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> In our study&#44; which had a similar design&#44; the percentage of expenditure attributed to direct costs was 86&#37;&#44; and mean cost per patient was lower&#44; perhaps due to the small percentage of cases with resistance&#44; including MDR&#46; This is in line with previous studies in Spain that reported an overall rate of 9&#46;2&#37; for drug resistance and 1&#46;9&#37; for MDR&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> The lower impact of indirect costs may derive from our use of an employment rate of 59&#37;&#44; retrieved from the official employment survey data&#44; for the calculation of costs derived from loss of productivity&#44; in contrast to the 71&#37; employment rate reported in the aforementioned series&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> Basing our calculations on a rate of 71&#37; would have increased indirect costs by approximately 16&#37;&#44; which would give us a result more in line with that obtained in the European study&#46; Nevertheless&#44; that study showed striking variations among our neighboring countries&#44; with mean costs ranging from &#8364;5691 to &#8364;8242 per patient&#46; These differences were supported by a study performed in Denmark where the mean direct cost of TB was &#8364;10&#44;509&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> In this country&#44; as in Spain&#44; the resistance rate is low&#44; and therefore the results of the Danish authors are similar to ours&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In our series&#44; costs were determined by hospitalization &#40;accounting for 61&#37; of total expenditure&#41;&#44; drug susceptibility testing&#44; DOT&#44; sick leave&#44; and chest CT&#46; The impact of hospital costs has already been addressed by Montes-Santiago et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> who observed that in Spain in 2006&#44; the cost of hospitalization for tuberculosis amounted to &#8364;30&#46;8 million&#46; Assuming that hospitalization accounts for 70&#37; of costs&#44; the total cost of tuberculosis was &#8364;40 million&#44; representing 0&#46;7&#37; of total public expenditure&#46; These authors also observed a slight fall in costs coinciding with fewer hospital admissions between 1999 and 2006&#46; Similarly&#44; in another series conducted in Germany&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> the cost of a hospital stay was practically 9 times that of treating the patient on an exclusively outpatient basis&#46; The same occurred in Denmark&#44; where hospitalization accounts for 81&#37; of costs&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> Furthermore&#44; in a national tuberculosis program in South Africa&#44; Pooran et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a> determined that costs generated by hospitalization accounted for a significant portion of total costs&#58; 56&#37; in their case&#46; Considering the above&#44; hospital admission for TB should be avoided as far as possible and limited to cases recommended in clinical guidelines<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> &#40;severe cases or disease complications and impossibility to isolate the patient at home&#41;&#44; in order to reduce the risk of transmission and disease-related costs&#46; Nonetheless&#44; the percentage of hospital admissions for tuberculosis remains high&#44; both in our sample&#44; where it was 59&#37;&#44; and in other national and international reports&#44; which range from 52&#37; to 78&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">7&#44;8&#44;11&#44;20&#44;21</span></a> although the reason for this high proportion remains unclear&#46; Thus&#44; a strategy aimed at reducing hospital stays would reduce costs&#44; as has already been observed in some regions which have managed to achieve rates as low as 34&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> If we take this figure and extrapolate our results to the number of TB cases notified in Spain in 2014&#44; we estimate that savings of &#8364;14 million could be achieved&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Steffen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> found that costs of DOT were significantly higher than the cost of self-administered treatment&#44; but that it increased&#44; albeit insignificantly&#44; the rate of treatment completion&#46; Furthermore&#44; a recent meta-analysis of studies performed mainly in south-east Asia and English-speaking countries showed that DOT does not improve outcomes in terms of microbiological cure&#44; prevention of relapse or development of acquired resistance compared to self-administered medication&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> so it seems reasonable to limit the use of DOT in countries with low to medium incidence to populations in special situations&#46; In our setting&#44; it is reserved solely for complicated cases or individuals with severe social problems who cannot follow their regimen normally&#46; DOT is currently used in less than 25&#37; of patients&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Our results also suggest that expenditure can also be reduced by decreasing the duration of sick leave&#44; since earlier studies have shown that it has a significant impact on costs&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> We must bear in mind that the main objective is to reduce the transmission of the disease and that&#44; with standard treatment&#44; contagiousness is significantly reduced after 3 weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> After that time&#44; isolation measures can be lifted and the subject can return to the workplace&#46; This period coincides with the mean number of days of sick leave identified in our study&#44; so we can surmise that this aspect is not one of the most important in our setting&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">From all of the above&#44; then&#44; we can conclude that avoiding unnecessary hospital stays is the only way to reduce costs&#46; Nevertheless&#44; it is important to point out that&#44; since TB gives rise to significant healthcare costs &#40;extrapolating the data from our study to cases notified in 2015&#44; expenditure would amount to &#8364;51&#44;500&#44;000&#41;&#44; reducing the number of cases is the surest way to reduce costs&#46; This&#44; in turn&#44; highlights the importance of such proven cost-effective strategies as contact tracing and treatment of latent tuberculous infection&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Our study is limited in several ways&#46; Similarly to the studies discussed above&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12&#44;13</span></a> we have only included estimated indirect costs derived from loss of productivity&#44; rehabilitation therapies&#44; and contact tracing&#44; and have probably underestimated the real costs by failing to include other indirect costs&#44; such as transport&#44; food&#44; electricity&#44; maintenance&#44; and human resources incurred by personnel caring for these patients&#44; and the costs of primary care&#46; However&#44; many of these costs would have greater impact in countries lacking in resources and universal healthcare provision&#44; or in populations with a significant proportion of patients with special requirements &#40;which does not seem to be the case in our series&#41;&#46; Moreover&#44; the diagnosis and follow-up of these patients is generally performed in specialized care&#46; We also did not include costs derived from pharmacological side effects&#44; since most of them are reversible after discontinuation of the causative drug&#44; and do not require further measures&#46; The cost of adjuvant medication for gastrointestinal side effects is negligible&#46; We therefore believe that&#44; while it may be interesting to include these costs&#44; they would not significantly affect the final outcomes of our study&#44; and excluding them does not affect the validity of our conclusions&#46; Finally&#44; we used costing data from only 2 health services in our calculations&#44; so we are aware that due to the variations between the different autonomous communities and the fact that only 9 of these participated in the study&#44; our study may not reflect the exact cost of tuberculosis&#46; However&#44; we would like to point out that we aimed to use our data to obtain an approximate estimation&#44; and we believe that we have achieved this in a reasonable enough manner for our study to have meaning in this setting&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">Tuberculosis gives rise to significant healthcare costs&#44; generated by hospitalizations&#44; imaging studies&#44; directly observed treatment and the need for sick leave&#46; Hospital admission appears to be the factor with the most impact&#44; so strategies aimed at decreasing hospital stays would be essential if costs have to be reduced&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">This project was funded by <span class="elsevierStyleGrantSponsor" id="gs1">SEPAR</span> grant <span class="elsevierStyleGrantNumber" refid="gs1">136&#47;2013</span>&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Authorship</span><p id="par0165" class="elsevierStylePara elsevierViewall">Jos&#233; Antonio Gull&#243;n&#58; study concept&#46; Writing&#44; critical reading&#44; review and final approval of the manuscript&#46; Analysis of results&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Jos&#233; Mar&#237;a Garc&#237;a&#58; study concept&#46; Critical reading&#44; review and final approval of the manuscript&#46; Analysis of results&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Manuel &#193;ngel Villanueva and Fernando &#193;lvarez-Navascues&#58; study concept&#46; Analysis of results&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Teresa Rodrigo and Joan Cayl&#225;&#58; critical reading&#44; review and final approval of the manuscript&#46; Analysis of results&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Mart&#237; Casals&#58; statistical analysis&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Marta Garc&#237;a-Clemente&#44; Luis Anibarro&#44; Mar&#237;a &#193;ngeles Jim&#233;nez&#44; Ana Bustamante&#44; Ant&#243;n Penas and Jos&#233; Antonio Caminero&#58; critical reading&#44; review and final approval of the manuscript&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">PII TB Working Group&#58; data collection&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflict of Interests</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the direct and indirect costs of diagnosis and management of tuberculosis &#40;TB&#41; and associated factors&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospective study of patients diagnosed with TB between September 2014 and September 2015&#46; We calculated direct &#40;hospital stays&#44; visits&#44; diagnostic tests&#44; and treatment&#41; and indirect &#40;sick leave and loss of productivity&#44; contact tracing&#44; and rehabilitation&#41; costs&#46; The following cost-related variables were compared&#58; age&#44; gender&#44; country of origin&#44; hospital stays&#44; diagnostic testing&#44; sensitivity testing&#44; treatment&#44; resistance&#44; directed observed therapy &#40;DOT&#41;&#44; and days of sick leave&#46; Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio &#40;OR&#41; and corresponding 95&#37; confidence intervals&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">319 patients were included with a mean age of 56&#46;72&#177;20&#46;79 years&#46; The average cost was &#8364;10&#44;262&#46;62&#177;14&#44;961&#46;66&#44; which increased significantly when associated with hospital admission&#44; polymerase chain reaction&#44; sputum smears and cultures&#44; sensitivity testing&#44; chest computed tomography&#44; pleural biopsy&#44; drug treatment longer than nine months&#44; DOT and sick leave&#46; In the multivariate analysis&#44; hospitalization &#40;OR&#61;96&#46;8&#59; CI 29&#8211;472&#41;&#44; sensitivity testing &#40;OR&#61;4&#46;34&#59; CI 1&#46;71&#8211;12&#46;1&#41;&#44; chest CT &#40;OR&#61;2&#46;25&#59; CI 1&#46;08&#8211;4&#46;77&#41;&#44; DOT &#40;OR&#61;20&#46;76&#59; CI 4&#46;11&#8211;148&#41; and sick leave &#40;OR&#61;26&#46;9&#59; CI 8&#46;51&#8211;122&#41; showed an independent association with cost&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Tuberculosis gives rise to significant health spending&#46; In order to reduce these costs&#44; more control of transmission&#44; and fewer hospital admissions would be required&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar los costes directos e indirectos derivados del diagn&#243;stico y tratamiento de la tuberculosis &#40;TB&#41; y sus factores asociados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de pacientes diagnosticados de TB entre septiembre de 2014 y septiembre de 2015&#46; Se calcularon los costes directos &#40;estancias hospitalarias&#44; consultas&#44; estudios diagn&#243;sticos y tratamiento&#41;&#44; e indirectos &#40;absentismo laboral y p&#233;rdida de productividad&#44; estudio de contactos y medidas rehabilitadoras&#41;&#46; Los costes se compararon atendiendo a las variables&#58; edad&#44; sexo&#44; pa&#237;s de origen&#44; ingreso hospitalario&#44; pruebas diagn&#243;sticas&#44; tratamiento&#44; resistencia farmacol&#243;gica&#44; tratamiento directamente observado &#40;TDO&#41; y d&#237;as de baja laboral&#46; Se compararon proporciones mediante Chi cuadrado y las variables significativas se incluyeron en un modelo de regresi&#243;n log&#237;stica calcul&#225;ndose las <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; y sus correspondientes intervalos de confianza del 95&#37; &#40;IC&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fueron incluidos 319 pacientes con una edad media de 56&#44;72&#177;20&#44;79 a&#241;os&#46; El coste medio fue de 10&#46;262&#44;62&#177;14&#46;961&#44;66<span class="elsevierStyleHsp" style=""></span>&#8364;&#44; y aumentaba significativamente en relaci&#243;n con el ingreso hospitalario&#44; el uso de la PCR&#44; la realizaci&#243;n de baciloscopia y cultivo&#44; antibiograma&#44; tomograf&#237;a axial computarizada de t&#243;rax&#44; biopsia pleural&#44; tratamiento de m&#225;s de 9 meses&#44; TDO y baja laboral&#46; En el an&#225;lisis multivariante manten&#237;an asociaci&#243;n independiente&#58; ingreso hospitalario &#40;OR&#61;96&#44;8&#59; IC&#58; 29-472&#44;3&#41;&#44; antibiograma &#40;OR&#61;4&#44;34&#59; IC&#58; 1&#44;71-12&#44;1&#41;&#44; tomograf&#237;a axial computarizada de t&#243;rax &#40;OR&#61;2&#44;25&#59; IC&#58; 1&#44;08-4&#44;77&#41;&#44; TDO &#40;OR&#61;20&#44;76&#59; IC&#58; 4&#44;11-148&#41; y baja laboral &#40;OR&#61;26&#44;9&#59; IC&#58; 8&#44;51-122&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La Tuberculosis acarrea un gasto sanitario significativo&#46; Medidas dirigidas a mejorar el control de la enfermedad y disminuir los ingresos hospitalarios ser&#237;an importantes para reducirlo&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
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    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gull&#243;n JA&#44; Garc&#237;a-Garc&#237;a JM&#44; Villanueva M&#193;&#44; &#193;lvarez-Navascues F&#44; Rodrigo T&#44; Casals M&#44; et al&#46; Costes de la tuberculosis en Espa&#241;a&#58; factores relacionados&#46; Arch Bronconeumol&#46; 2016&#59;52&#58;583&#8211;589&#46;</p>"
      ]
      1 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Members of the Integrated Tuberculosis Research Program &#40;PIITB&#41; Working Group are listed in <a class="elsevierStyleCrossRef" href="#sec0095">Annex</a>&#46;</p>"
        "identificador" => "fn0005"
      ]
    ]
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          0 => array:4 [
            "apendice" => "<p id="par0205" class="elsevierStylePara elsevierViewall">N&#46; Altet &#40;Serveis Clinics&#44; Barcelona&#41;&#59; E&#46; Biku&#241;a &#40;Hospital de Zum&#225;rraga&#44; Zum&#225;rraga&#41;&#59; E&#46; Carri&#243; &#40;Centro Asistencial Dr&#46; Emili Mira i L&#243;pez&#41;&#59; X&#46; Casas &#40;Hospital de Sant Boi&#44; Llobregat&#41;&#59; F&#46;J&#46; Garros &#40;Hospital Santa Marina&#44; Bilbao&#41;&#59; M&#46; Jim&#233;nez &#40;Hospital Universitario de Donostia&#44; Donostia&#41;&#59; I&#46; L&#243;pez &#40;Hospital Universitario de Cruces&#44; Barakaldo&#41;&#59; M&#46; Mar&#237;n &#40;Hospital General de Castell&#243;n&#44; Castell&#243;n&#41;&#59; J&#46;F&#46; Medina &#40;Hospital Universitario Virgen del Roc&#237;o&#44; Sevilla&#41;&#59; J&#46;P&#46; Millet &#40;Serveis Clinics&#44; Barcelona&#41;&#59; I&#46; Mir &#40;Hospital Son Llatzer&#44; Palma de Mallorca&#41;&#59; Laura Rodr&#237;guez &#40;Hospital Universitario Germans Tr&#237;as i Pujol&#44; Badalona&#41;&#59; F&#46; S&#225;nchez &#40;Hospital del Mar&#44; Barcelona&#41;&#46;</p>"
            "etiqueta" => "Annex"
            "titulo" => "Tuberculosis Research Integrated Program Working Group &#40;PIITB&#41;"
            "identificador" => "sec0095"
          ]
        ]
      ]
    ]
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of cases by autonomous communities&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">MDR&#58; resistance to rifampicin and isoniazid&#59; CT&#58; computed tomography&#59; DOT&#58; directly observed treatment&#59; PCR&#58; polymerase chain reaction&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hospital stay&#47;day</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">403&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Stay in other healthcare facility&#47;day</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">126&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Visit</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>First&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">120&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Successive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Laboratory tests &#40;complete blood count&#44; liver function&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mycobacteria &#40;sputum smear and culture&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Drug susceptibility testing</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">PCR</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Standard chest radiograph</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chest CT with contrast medium</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">202&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Bronchoscopy and bronchial aspiration</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">151&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Bronchoscopy with biopsy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">215&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pleural biopsy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CT-guided percutaneous biopsy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">266&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Extrathoracic biopsy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Treatment</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6 months</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>3 drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">224&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>4 drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">206&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>9 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Isoniazid resistance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">517&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rifampicin resistance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2079&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MDR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7834&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">DOT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Median Cost</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Bivariate Analysis</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate Analysis</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">&#60;&#8364;4573&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">&#8805;&#8364;4573&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;60&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;39&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;43&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112 &#40;56&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;02 &#40;1&#46;25&#8211;3&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;20 &#40;0&#46;99&#8211;5&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>18&#8211;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;50&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;49&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>31&#8211;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;03 &#40;0&#46;58&#8211;1&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;48&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;51&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;09 &#40;0&#46;60&#8211;1&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Country of origin</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Spanish-born&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;53&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101 &#40;46&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Immigrant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;42&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;57&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;52 &#40;0&#46;95&#8211;2&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Hospital admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111 &#40;84&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;15&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139 &#40;74&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;1 &#40;8&#46;66&#8211;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&#46;8 &#40;29&#8211;472&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Other healthcare facility</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">158 &#40;57&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117 &#40;42&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;97&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;6 &#40;10&#46;9&#8211;119&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;29 &#40;0&#46;67&#8211;8&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">PCR</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;65&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;34&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82 &#40;40&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119 &#40;50&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;71 &#40;1&#46;70&#8211;4&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;06 &#40;1&#46;09&#8211;11&#46;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">SS and culture</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;73&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;26&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">151 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;09 &#40;1&#46;43&#8211;7&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Drug susceptibilty testing</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;70&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;29&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;42&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135 &#40;57&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;16 &#40;1&#46;87&#8211;5&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;34 &#40;1&#46;71&#8211;12&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Resistance</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">153 &#40;50&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152 &#40;49&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;42&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;13 &#40;0&#46;44&#8211;4&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Chest CT</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104 &#40;58&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;41&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;19 &#40;1&#46;40&#8211;3&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;25 &#40;1&#46;08&#8211;4&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Pleural biopsy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155 &#40;51&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">145 &#40;48&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;78&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;89 &#40;1&#46;36&#8211;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;70 &#40;0&#46;95&#8211;28&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Bronchoscopy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;54&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;45&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;48&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122 &#40;51&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;31 &#40;0&#46;79&#8211;2&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">121 &#40;53&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104 &#40;46&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>9 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;31 &#40;0&#46;76&#8211;2&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prolonged&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;43 &#40;1&#46;45&#8211;9&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;26 &#40;0&#46;95&#8211;8&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">DOT</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">154 &#40;61&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98 &#40;38&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;92&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;81 &#40;7&#46;79&#8211;56&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;7 &#40;4&#46;11&#8211;148&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Sick leave</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">128 &#40;55&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102 &#40;44&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;34&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;65&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;34 &#40;1&#46;41&#8211;3&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;9 &#40;8&#46;51&#8211;122&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Bivariate and Multivariate Analysis&#46;</p>"
        ]
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:23 [
            0 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available from&#58; <a class="elsevierStyleInterRef" id="intr0010" href="http://www.who.int/tbpublications/global_report/es">www&#46;who&#46;int&#47;tbpublications&#47;global&#95;report&#47;es</a> &#91;accessed 04&#46;02&#46;16&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Global Tuberculosis Report 2014"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2016"
                        "editorial" => "World Health Organization"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available from&#58; http&#58;&#47;&#47;www&#46;isciii&#46;es&#47;ISCIII&#47;es&#47;contenidos&#47;fd&#8230;&#47;TB&#95;Informe&#95;2014&#46;pdf"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Informe epidemiol&#243;gico sobre la situaci&#243;n de la tuberculosis en Espa&#241;a&#46; A&#241;o 2014"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Rodr&#237;guez"
                            1 => "S&#46; Villarrubia"
                            2 => "E&#46;V&#46; Mart&#237;nez"
                            3 => "R&#46; Amillategui"
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Article information
ISSN: 15792129
Original language: English
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