Scaling up target regimens for tuberculosis preventive treatment in Brazil and South Africa: An analysis of costs and cost- effectiveness
Scaling up target regimens for tuberculosis preventive treatment in Brazil and South Africa: An analysis of costs and cost- effectiveness
Data
2022
Autores
Nsengiyumva, Ntwali Placide
Campbell, Jonathon R.
Oxlade, Olivia
Vesga, Juan F.
Lienhardt, Christian
Trajman, Anete
Falzon, Dennis
Boon, Saskia Den
Arinaminpathy, Nimalan
Schwartzman, Kevin
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS Medicine
Resumo
Background
Shorter, safer, and cheaper tuberculosis (TB) preventive treatment (TPT) regimens will
enhance uptake and effectiveness. WHO developed target product profiles describing mini-
mum requirements and optimal targets for key attributes of novel TPT regimens. We per-
formed a cost-effectiveness analysis addressing the scale-up of regimens meeting these
criteria in Brazil, a setting with relatively low transmission and low HIV and rifampicin-resis-
tant TB (RR-TB) prevalence, and South Africa, a setting with higher transmission and higher
HIV and RR-TB prevalence.
Methods and findings
We used outputs from a model simulating scale-up of TPT regimens meeting minimal and
optimal criteria. We assumed that drug costs for minimal and optimal regimens were identi-
cal to 6 months of daily isoniazid (6H). The minimal regimen lasted 3 months, with 70% com-
pletion and 80% efficacy; the optimal regimen lasted 1 month, with 90% completion and
100% efficacy. Target groups were people living with HIV (PLHIV) on antiretroviral treatment
and household contacts (HHCs) of identified TB patientsAU. The: Icha statusngedquoidenwas tifiedin 6HdexT at 2019 BpatientstoidentifiedTBpatients:Ifthisisnotcorrect; pleaseeditasnecessary:
coverage levels for PLHIV and HHCs. We projected TB cases and deaths, TB-associated
disability-adjusted life years (DALYs), and costs (in 2020 US dollars) associated with TB
from a TB services perspective from 2020 to 2035, with 3% annual discounting. We esti-
mated the expected costs and outcomes of scaling up 6H, the minimal TPT regimen, or the optimal TPT regimen to reach all eligible PLHIV and HHCs by 2023, compared to the status
quo. Maintaining current 6H coverage in Brazil (0% of HHCs and 30% of PLHIV treated)
would be associated with 1.1 (95% uncertainty range [UR] 1.1–1.2) million TB cases,
123,000 (115,000–132,000) deaths, and 2.5 (2.1–3.1) million DALYs and would cost $1.1
($1.0–$1.3) billion during 2020–2035. Expanding the 6H, minimal, or optimal regimen to
100% coverage among eligible groups would reduce DALYs by 0.5% (95% UR 1.2% reduc-
tion, 0.4% increase), 2.5% (1.8%–3.0%), and 9.0% (6.5%–11.0%), respectively, with addi-
tional costs of $107 ($95–$117) million and $51 ($41–$60) million and savings of $36 ($14–
$58) million, respectively. Compared to the status quo, costs per DALY averted were
$7,608 and $808 for scaling up the 6H and minimal regimens, respectively, while the optimal
regimen was dominant (cost savings, reduced DALYs). In South Africa, maintaining current
6H coverage (0% of HHCs and 69% of PLHIV treated) would be associated with 3.6 (95%
UR 3.0–4.3) million TB cases, 843,000 (598,000–1,201,000) deaths, and 36.7 (19.5–58.0)
million DALYs and would cost $2.5 ($1.8–$3.6) billion. Expanding coverage with the 6H,
minimal, or optimal regimen would reduce DALYs by 6.9% (95% UR 4.3%–95%), 15.5%
(11.8%–18.9%), and 38.0% (32.7%–43.0%), respectively, with additional costs of $79 (−$7,
$151) million and $40 (−$52, $140) millionAUand: savings Ichangedofadd$608 itionalc ($443–$832) ostsof 79ðsamillion, vings7;respec- additional151Þmillionand40ðsavings52; additional140Þmilliontoadditionalcostsof 79ð
7; 151Þmillionand40ð
52;140Þmillion:Ifthiseditdoesnotcaptureyourmeaning; pleaseeditasnecessary:
tively. Compared to the status quo, estimated costs per DALY averted were $31 and $7 for
scaling up the 6H and minimal regimens, while the optimal regimen was dominant. Study
limitations included the focus on 2 countries, and no explicit consideration of costs incurred
before the decision to prescribe TPT.
Conclusions
Our findings suggest that scale-up of TPT regimens meeting minimum or optimal require-
ments would likely have important impacts on TB-associated outcomes and would likely be
cost-effective or cost saving.
Description
Palavras-chave
Antitubercular Agents / therapeutic use, Brazil / epidemiology, Cost-Benefit Analysis, HIV Infections* / drug therapy, HIV Infections* / epidemiology, HIV Infections* / prevention & control, Humans, South Africa / epidemiology, Tuberculosis, Multidrug-Resistant* / drug therapy
Citação
Nsengiyumva NP, Campbell JR, Oxlade O, Vesga JF, Lienhardt C, Trajman A, Falzon D, Den Boon S, Arinaminpathy N, Schwartzman K. Scaling up target regimens for tuberculosis preventive treatment in Brazil and South Africa: An analysis of costs and cost-effectiveness. PLoS Med. 2022 Jun 13;19(6):e1004032. doi: 10.1371/journal.pmed.1004032.