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Cost of Delivering 12-Dose Isoniazid and Rifapentine Versus 6 Months of Isoniazid for Tuberculosis Infection in a High-Burden Setting.
Clin Infect Dis. 2021 09 07; 73(5):e1135-e1141.CI

Abstract

BACKGROUND

Successful delivery and completion of tuberculosis preventive treatment are necessary for tuberculosis elimination. Shorter preventive treatment regimens currently have higher medication costs, but patients spend less time in care and are more likely to complete treatment. It is unknown how economic costs of successful delivery differ between longer and shorter regimens in high-tuberculosis-burden settings.

METHODS

We developed survey instruments to collect costs from program and patient sources, considering costs incurred from when household contacts first entered the health system. We compared the cost per completed course of preventive treatment with either 6 months of daily isoniazid (6H) or 3 months of weekly isoniazid and rifapentine (3HP), delivered by the Indus Health Network tuberculosis program in Karachi, Pakistan, between October 2016 and February 2018.

RESULTS

During this period, 459 individuals initiated 6H and 643 initiated 3HP; 39% and 61% completed treatment, respectively. Considering costs to both the program and care recipients, the cost per completed course was 394 US dollars (USD) for 6H and 333 USD for 3HP. Using a new 2020 price for rifapentine reduced the cost per completed course of 3HP to 290 USD. Under varying assumptions about drug prices and costs incurred by care recipients, the cost per completed course was lower for 3HP in all scenarios, and the largest cost drivers were the salaries of clinical staff.

CONCLUSIONS

In a high-burden setting, the cost of successful delivery of 3HP was lower than that of 6H, driven by higher completion.

Authors+Show Affiliations

Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts, USA.Interactive Research and Development, Karachi, Pakistan.Global Health Directorate, Indus Health Network, Karachi, Pakistan.Global Health Directorate, Indus Health Network, Karachi, Pakistan.Global Health Directorate, Indus Health Network, Karachi, Pakistan. Interactive Research and Development (IRD) Global, Singapore.Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts, USA. Interactive Research and Development (IRD) Global, Singapore.Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts, USA.Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts, USA.Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.Interactive Research and Development (IRD) Global, Singapore.

Pub Type(s)

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

Language

eng

PubMed ID

33289039

Citation

Yuen, Courtney M., et al. "Cost of Delivering 12-Dose Isoniazid and Rifapentine Versus 6 Months of Isoniazid for Tuberculosis Infection in a High-Burden Setting." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 73, no. 5, 2021, pp. e1135-e1141.
Yuen CM, Majidulla A, Jaswal M, et al. Cost of Delivering 12-Dose Isoniazid and Rifapentine Versus 6 Months of Isoniazid for Tuberculosis Infection in a High-Burden Setting. Clin Infect Dis. 2021;73(5):e1135-e1141.
Yuen, C. M., Majidulla, A., Jaswal, M., Safdar, N., Malik, A. A., Khan, A. J., Becerra, M. C., Keshavjee, S., Lu, C., & Hussain, H. (2021). Cost of Delivering 12-Dose Isoniazid and Rifapentine Versus 6 Months of Isoniazid for Tuberculosis Infection in a High-Burden Setting. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 73(5), e1135-e1141. https://doi.org/10.1093/cid/ciaa1835
Yuen CM, et al. Cost of Delivering 12-Dose Isoniazid and Rifapentine Versus 6 Months of Isoniazid for Tuberculosis Infection in a High-Burden Setting. Clin Infect Dis. 2021 09 7;73(5):e1135-e1141. PubMed PMID: 33289039.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost of Delivering 12-Dose Isoniazid and Rifapentine Versus 6 Months of Isoniazid for Tuberculosis Infection in a High-Burden Setting. AU - Yuen,Courtney M, AU - Majidulla,Arman, AU - Jaswal,Maria, AU - Safdar,Nauman, AU - Malik,Amyn A, AU - Khan,Aamir J, AU - Becerra,Mercedes C, AU - Keshavjee,Salmaan, AU - Lu,Chunling, AU - Hussain,Hamidah, PY - 2020/10/05/received PY - 2020/12/9/pubmed PY - 2021/9/23/medline PY - 2020/12/8/entrez KW - Pakistan KW - chemoprevention KW - costs and cost analysis KW - latent tuberculosis KW - rifapentine SP - e1135 EP - e1141 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 73 IS - 5 N2 - BACKGROUND: Successful delivery and completion of tuberculosis preventive treatment are necessary for tuberculosis elimination. Shorter preventive treatment regimens currently have higher medication costs, but patients spend less time in care and are more likely to complete treatment. It is unknown how economic costs of successful delivery differ between longer and shorter regimens in high-tuberculosis-burden settings. METHODS: We developed survey instruments to collect costs from program and patient sources, considering costs incurred from when household contacts first entered the health system. We compared the cost per completed course of preventive treatment with either 6 months of daily isoniazid (6H) or 3 months of weekly isoniazid and rifapentine (3HP), delivered by the Indus Health Network tuberculosis program in Karachi, Pakistan, between October 2016 and February 2018. RESULTS: During this period, 459 individuals initiated 6H and 643 initiated 3HP; 39% and 61% completed treatment, respectively. Considering costs to both the program and care recipients, the cost per completed course was 394 US dollars (USD) for 6H and 333 USD for 3HP. Using a new 2020 price for rifapentine reduced the cost per completed course of 3HP to 290 USD. Under varying assumptions about drug prices and costs incurred by care recipients, the cost per completed course was lower for 3HP in all scenarios, and the largest cost drivers were the salaries of clinical staff. CONCLUSIONS: In a high-burden setting, the cost of successful delivery of 3HP was lower than that of 6H, driven by higher completion. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/33289039/Cost_of_Delivering_12_Dose_Isoniazid_and_Rifapentine_Versus_6_Months_of_Isoniazid_for_Tuberculosis_Infection_in_a_High_Burden_Setting_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciaa1835 DB - PRIME DP - Unbound Medicine ER -