Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis
Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis
Data
2016
Autores
Gomez, G. B.
Dowdy, D. W.
Bastos, M. L.
Zwerling, A.
Sweeney, S.
Foster, N.
Trajman, A.
Islam, M. A.
Kapiga, S.
Sinanovic, E.
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Infectious Diseases
Resumo
Background: Despite 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.
Methods: We 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.
Results: From 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.
Conclusion: Reducing 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.
Description
Palavras-chave
Tuberculosis, Cost-effectiveness, Economic evaluation, New technologies.
Citação
Gomez GB, Dowdy DW, Bastos ML, Zwerling A, Sweeney S, Foster N, Trajman A, Islam MA, Kapiga S, Sinanovic E, Knight GM, White RG, Wells WA, Cobelens FG, Vassall A. Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis. BMC Infect Dis. 2016 Dec 1;16(1):726. doi: 10.1186/s12879-016-2064-3.