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Cost-effectiveness of 3 months of weekly rifapentine and isoniazid compared with other standard treatment regimens for latent tuberculosis infection: a decision analysis study.
J Antimicrob Chemother. 2019 01 01; 74(1):218-227.JA

Abstract

Background

Latent tuberculosis infection (LTBI) is a critical driver of the global burden of active TB, and therefore LTBI treatment is key for TB elimination. Treatment regimens for LTBI include self-administered daily isoniazid for 6 (6H) or 9 (9H) months, self-administered daily rifampicin plus isoniazid for 3 months (3RH), self-administered daily rifampicin for 4 months (4R) and weekly rifapentine plus isoniazid for 3 months self-administered (3HP-SAT) or administered by a healthcare worker as directly observed therapy (3HP-DOT). Data on the relative cost-effectiveness of these regimens are needed to assist policymakers and clinicians in selecting an LTBI regimen.

Objectives

To evaluate the cost-effectiveness of all regimens for treating LTBI.

Methods

We developed a Markov model to investigate the cost-effectiveness of 3HP-DOT, 3HP-SAT, 4R, 3RH, 9H and 6H for LTBI treatment in a cohort of 10000 adults with LTBI. Cost-effectiveness was evaluated from a health system perspective over a 20 year time horizon.

Results

Compared with no preventive treatment, 3HP-DOT, 3HP-SAT, 4R, 3RH, 9H and 6H prevented 496, 470, 442, 418, 370 and 276 additional cases of active TB per 10000 patients, respectively. All regimens reduced costs and increased QALYs compared with no preventive treatment. 3HP was more cost-effective under DOT than under SAT at a cost of US$27948 per QALY gained.

Conclusions

Three months of weekly rifapentine plus isoniazid is more cost-effective than other regimens. Greater recognition of the benefits of short-course regimens can contribute to the scale-up of prevention and achieving the 'End TB' targets.

Authors+Show Affiliations

Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia. Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia.Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia.The Burnet Institute, Melbourne, Australia.Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia. The Burnet Institute, Melbourne, Australia. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.Research School of Population Health, The Australian National University, Canberra, Australia. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia. Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30295760

Citation

Doan, Tan N., et al. "Cost-effectiveness of 3 Months of Weekly Rifapentine and Isoniazid Compared With Other Standard Treatment Regimens for Latent Tuberculosis Infection: a Decision Analysis Study." The Journal of Antimicrobial Chemotherapy, vol. 74, no. 1, 2019, pp. 218-227.
Doan TN, Fox GJ, Meehan MT, et al. Cost-effectiveness of 3 months of weekly rifapentine and isoniazid compared with other standard treatment regimens for latent tuberculosis infection: a decision analysis study. J Antimicrob Chemother. 2019;74(1):218-227.
Doan, T. N., Fox, G. J., Meehan, M. T., Scott, N., Ragonnet, R., Viney, K., Trauer, J. M., & McBryde, E. S. (2019). Cost-effectiveness of 3 months of weekly rifapentine and isoniazid compared with other standard treatment regimens for latent tuberculosis infection: a decision analysis study. The Journal of Antimicrobial Chemotherapy, 74(1), 218-227. https://doi.org/10.1093/jac/dky403
Doan TN, et al. Cost-effectiveness of 3 Months of Weekly Rifapentine and Isoniazid Compared With Other Standard Treatment Regimens for Latent Tuberculosis Infection: a Decision Analysis Study. J Antimicrob Chemother. 2019 01 1;74(1):218-227. PubMed PMID: 30295760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of 3 months of weekly rifapentine and isoniazid compared with other standard treatment regimens for latent tuberculosis infection: a decision analysis study. AU - Doan,Tan N, AU - Fox,Greg J, AU - Meehan,Michael T, AU - Scott,Nick, AU - Ragonnet,Romain, AU - Viney,Kerri, AU - Trauer,James M, AU - McBryde,Emma S, PY - 2018/06/26/received PY - 2018/09/05/accepted PY - 2018/10/9/pubmed PY - 2020/1/15/medline PY - 2018/10/9/entrez SP - 218 EP - 227 JF - The Journal of antimicrobial chemotherapy JO - J Antimicrob Chemother VL - 74 IS - 1 N2 - Background: Latent tuberculosis infection (LTBI) is a critical driver of the global burden of active TB, and therefore LTBI treatment is key for TB elimination. Treatment regimens for LTBI include self-administered daily isoniazid for 6 (6H) or 9 (9H) months, self-administered daily rifampicin plus isoniazid for 3 months (3RH), self-administered daily rifampicin for 4 months (4R) and weekly rifapentine plus isoniazid for 3 months self-administered (3HP-SAT) or administered by a healthcare worker as directly observed therapy (3HP-DOT). Data on the relative cost-effectiveness of these regimens are needed to assist policymakers and clinicians in selecting an LTBI regimen. Objectives: To evaluate the cost-effectiveness of all regimens for treating LTBI. Methods: We developed a Markov model to investigate the cost-effectiveness of 3HP-DOT, 3HP-SAT, 4R, 3RH, 9H and 6H for LTBI treatment in a cohort of 10000 adults with LTBI. Cost-effectiveness was evaluated from a health system perspective over a 20 year time horizon. Results: Compared with no preventive treatment, 3HP-DOT, 3HP-SAT, 4R, 3RH, 9H and 6H prevented 496, 470, 442, 418, 370 and 276 additional cases of active TB per 10000 patients, respectively. All regimens reduced costs and increased QALYs compared with no preventive treatment. 3HP was more cost-effective under DOT than under SAT at a cost of US$27948 per QALY gained. Conclusions: Three months of weekly rifapentine plus isoniazid is more cost-effective than other regimens. Greater recognition of the benefits of short-course regimens can contribute to the scale-up of prevention and achieving the 'End TB' targets. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/30295760/Cost_effectiveness_of_3_months_of_weekly_rifapentine_and_isoniazid_compared_with_other_standard_treatment_regimens_for_latent_tuberculosis_infection:_a_decision_analysis_study_ DB - PRIME DP - Unbound Medicine ER -