Cost-Effective Monitoring of MDR-TB Treatment: A Comparative Assessment of C-Reactive Protein and Erythrocyte Sedimentation Rate in a High-Burden Setting

Abstract

Background: Monitoring treatment response in multidrug-resistant tuberculosis (MDR-TB) is challenging, particularly in resource-limited settings. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are inexpensive and routinely available inflammatory markers that may provide complementary information during treatment. Objective: To compare the effectiveness and potential cost implications of serial CRP and ESR measurements for monitoring treatment response among patients with MDR-TB during the first three months of therapy. Methodology: This prospective prognostic cohort study was conducted at the Programmatic Management of Drug-Resistant Tuberculosis Unit of Lady Reading Hospital and Khyber Medical College, Peshawar, from January 2024 to June 2025. Patients with confirmed MDR-TB were followed for three months with monthly clinical assessment, sputum examination, CRP, and ESR measurements. Treatment response was assessed by sputum conversion. Changes in biomarkers were analyzed using repeated-measures ANOVA, while factors associated with unfavorable outcomes were assessed using logistic regression. Results: Of 102 enrolled patients, 92 completed follow-up and were included in the final analysis. The mean age was 37.2 ± 13.8 years, and 52.2% were male. Sputum conversion was achieved in 65 (70.6%) patients. Mean CRP decreased progressively from 30.8 ± 27.4 mg/dL at baseline to 19.8 ± 18.6, 12.4 ± 12.9, and 9.6 ± 10.2 mg/dL at months 1, 2, and 3, respectively (P < 0.001). ESR similarly declined from 52.6 ± 31.8 to 40.2 ± 28.5, 29.8 ± 24.6, and 24.4 ± 22.1 mm/h (P < 0.001). CRP improved in 88.0% and ESR in 85.9% of patients. Conclusion: Serial CRP and ESR demonstrated significant declines during MDR-TB treatment and may serve as useful complementary markers of treatment response. ESR may be particularly practical where resources are limited, although formal cost-effectiveness studies are required.