Impact of treatment completion, intolerance and adverse events on health system costs in a randomised trial of 4 months rifampin or 9 months isoniazid for latent TB
Impact of treatment completion, intolerance and adverse events on health system costs in a randomised trial of 4 months rifampin or 9 months isoniazid for latent TB
Data
2010
Autores
Aspler, Anne
Long, Richard
Trajman, Anete
Dion, Marie-Josée
Khan, Kamran
Schwartzman, Kevin
Menzies, Dick
Journal Title
Journal ISSN
Volume Title
Publisher
Thorax
Resumo
Rationale Treatment for latent tuberculosis infection with
isoniazid for 9 months (9INH) has poor completion and
serious adverse events, while treatment for 4 months
with daily rifampin (4RIF) has significantly higher
completion and fewer adverse events.
Objectives To compare the health system costs of 4RIF
and 9INH.
Methods In a randomised trial conducted in five
Canadian centres, one Brazilian and one Saudi Arabian
centre, consenting subjects were randomised to receive
4RIF or 9INH. Health system costs were estimated from
healthcare utilisation including scheduled and
unscheduled visits, investigations and drugs. All activities
for all subjects were evaluated using financial information
from 2007 from the Montreal Chest Institute. Costs were
expressed in Canadian dollars.
Results Total health system cost per patient allocated to
4RIF was $854 compared with $970 for 9INH (p<0.0001).
The average cost per patient for the 328 of 420 (78%) who
completed 4RIF therapy was $1094 compared with $1625
for the 254 of 427 (60%) completing 9INH (p<0.0001).
Costs were modestly increased in patients with minor
intolerance and substantially increased if the treating
physician stopped treatment because of possible adverse
events. Total costs related to management of adverse
events with 9INH were $48 142 compared with $25 684
for 4RIF (p1⁄40.008). Using these data, incremental cost-
effectiveness analyses showed that 4RIF would be cost
saving and prevent more cases within 2 years if efficacy
exceeded 74%, and cost saving if efficacy exceeded 65%.
Conclusions The 4RIF regimen was significantly
cheaper per patient completing treatment because of
better completion and fewer adverse events.
RCT registration number NCT00170209.
Description
Palavras-chave
Adult, Antibiotics, Antitubercular / administration & dosage, Antibiotics, Antitubercular / adverse effects, Antibiotics, Antitubercular / economics*, Brazil, Canada, Cost-Benefit Analysis, Drug Administration Schedule, Drug Costs / statistics & numerical data, Health Care Costs / statistics & numerical data*, Health Services / statistics & numerical data, Humans, Isoniazid / administration & dosage, Isoniazid / adverse effects, Isoniazid / economics, Latent Tuberculosis / drug therapy*, Latent Tuberculosis / economics*, Rifampin / administration & dosage, Rifampin / adverse effects, Rifampin / economics*, Saudi Arabia
Citação
Aspler A, Long R, Trajman A, Dion MJ, Khan K, Schwartzman K, Menzies D. Impact of treatment completion, intolerance and adverse events on health system costs in a randomised trial of 4 months rifampin or 9 months isoniazid for latent TB. Thorax. 2010 Jul;65(7):582-7. doi: 10.1136/thx.2009.125054.