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 language | English (US) |
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Pages (from-to) | 590-596 |
Number of pages | 7 |
Journal | International Journal of Tuberculosis and Lung Disease |
Volume | 17 |
Issue number | 5 |
DOIs | |
State | Published - May 1 2013 |
Keywords
- Anti-tuberculosis agents
- Cost-benefit analysis
- Drugs, investigational
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Infectious Diseases