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BMC Infect Dis. 2016 Dec 1;16(1):726.

Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis.

Author information

1
Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center, University of Amsterdam, Trinity Building C, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands. g.gomez@aighd.org.
2
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. g.gomez@aighd.org.
3
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
4
Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
5
Tuberculosis Scientific League, Rio de Janeiro, Brazil.
6
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
7
Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
8
McGill University, Montreal, Canada.
9
BRAC Health Nutrition and Population Programme, BRAC Centre, Dhaka, Bangladesh.
10
Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
11
TB Modelling Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
12
Global Alliance for TB Drug Development, New York, USA.
13
Present address: United States Agency for International Development, Washington, DC, USA.
14
Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center, University of Amsterdam, Trinity Building C, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands.
15
KNCV Tuberculosis Foundation, The Hague, Netherlands.

Abstract

BACKGROUND:

Despite improvements in treatment success rates for tuberculosis (TB), current six-month regimen duration remains a challenge for many National TB Programmes, health systems, and patients. There is increasing investment in the development of shortened regimens with a number of candidates in phase 3 trials.

METHODS:

We developed an individual-based decision analytic model to assess the cost-effectiveness of a hypothetical four-month regimen for first-line treatment of TB, assuming non-inferiority to current regimens of six-month duration. The model was populated using extensive, empirically-collected data to estimate the economic impact on both health systems and patients of regimen shortening for first-line TB treatment in South Africa, Brazil, Bangladesh, and Tanzania. We explicitly considered 'real world' constraints such as sub-optimal guideline adherence.

RESULTS:

From a societal perspective, a shortened regimen, priced at USD1 per day, could be a cost-saving option in South Africa, Brazil, and Tanzania, but would not be cost-effective in Bangladesh when compared to one gross domestic product (GDP) per capita. Incorporating 'real world' constraints reduces cost-effectiveness. Patient-incurred costs could be reduced in all settings. From a health service perspective, increased drug costs need to be balanced against decreased delivery costs. The new regimen would remain a cost-effective option, when compared to each countries' GDP per capita, even if new drugs cost up to USD7.5 and USD53.8 per day in South Africa and Brazil; this threshold was above USD1 in Tanzania and under USD1 in Bangladesh.

CONCLUSION:

Reducing the duration of first-line TB treatment has the potential for substantial economic gains from a patient perspective. The potential economic gains for health services may also be important, but will be context-specific and dependent on the appropriate pricing of any new regimen.

KEYWORDS:

Cost-effectiveness; Economic evaluation; New technologies; Tuberculosis

PMID:
27905897
PMCID:
PMC5131398
DOI:
10.1186/s12879-016-2064-3
[Indexed for MEDLINE]
Free PMC Article

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