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

BMC Infectious Diseases

Research Article

G. B. Gomez¹  F. G. Cobelens²  M. A. Islam³  D. W. Dowdy⁴  A. Zwerling⁴  A. Vassall⁵  S. Sweeney⁵  M. L. Bastos⁶  A. Trajman⁷  W. A. Wells⁸  E. Sinanovic⁹  N. Foster⁹  S. Kapiga^1,10  G. M. Knight^1,11  R. G. White^1,11 

[1] Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center, University of Amsterdam, Trinity Building C, Pietersbergweg 17, 1105 BM, Amsterdam, The Netherlands;Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK;Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center, University of Amsterdam, Trinity Building C, Pietersbergweg 17, 1105 BM, Amsterdam, The Netherlands;KNCV Tuberculosis Foundation, The Hague, Netherlands;BRAC Health Nutrition and Population Programme, BRAC Centre, Dhaka, Bangladesh;Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA;Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK;Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;Tuberculosis Scientific League, Rio de Janeiro, Brazil;Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;Tuberculosis Scientific League, Rio de Janeiro, Brazil;McGill University, Montreal, Canada;Global Alliance for TB Drug Development, New York, USA;Present address: United States Agency for International Development, Washington, DC, USA;Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa;Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania;TB Modelling Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK;

关键词: Tuberculosis;    Cost-effectiveness;    Economic evaluation;    New technologies;   

DOI  :  10.1186/s12879-016-2064-3

 received in 2016-03-10, accepted in 2016-11-08,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundDespite 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.MethodsWe 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.ResultsFrom 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.ConclusionReducing 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.

【 授权许可】

CC BY   
© The Author(s). 2016