Cost-effectiveness of novel first-line treatment regimens for tuberculosis

J. P. Owens, M. O. Fofana, David W. Dowdy

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To evaluate the cost-effectiveness of novel first-line treatment regimens for tuberculosis (TB). DESIGN: Using decision analysis, we projected the costs and effectiveness, from the health care perspective, of treating a patient cohort in the public sector for active TB without known or suspected resistance to first-line drugs. We compared standard (6-month) treatment to hypothetical regimens of equal efficacy, higher cost and shorter duration. RESULTS: For every 100 TB patients treated, replacing standard treatment with shorter-course regimens would avert an estimated 2-4 failures/relapses, 0.2-0.4 deaths and 8-14 disability-adjusted life years (DALYs), or 6-11% of all DALYs suffered. We identified three primary determinants of cost-effectiveness: drug price, continuation phase treatment delivery costs and deaths averted through fewer relapses. In a high treatment cost scenario (similar to Brazil), averted delivery costs outweighed higher drug costs, making novel regimens cost-saving. In a low treatment cost scenario (similar to the Philippines), a 4-month regimen with a drug price of $1/day cost $66 per patient, or $840 per DALY averted, and became cost-saving if the drug price dropped below $0.37/day. CONCLUSION: Although they avert a small proportion of total DALYs, novel, shorter-course first-line regimens for TB are likely to be cost-effective or cost-saving in most settings.

Original languageEnglish (US)
Pages (from-to)590-596
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume17
Issue number5
DOIs
StatePublished - May 1 2013

Keywords

  • Anti-tuberculosis agents
  • Cost-benefit analysis
  • Drugs, investigational

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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