Cost-effectiveness of short, oral treatment regimens for rifampicin resistant tuberculosis
Current options for treating tuberculosis (TB) that is resistant to rifampicin (RR-TB) are few, and regimens are often long and poorly tolerated. Following recent evidence from the TB-PRACTECAL trial countries are considering programmatic uptake of 6-month, all-oral treatment regimens. We used a Mar...
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| Vydáno v: | PLOS global public health Ročník 2; číslo 12; s. e0001337 |
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| Jazyk: | angličtina |
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2022
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| Abstract | Current options for treating tuberculosis (TB) that is resistant to rifampicin (RR-TB) are few, and regimens are often long and poorly tolerated. Following recent evidence from the TB-PRACTECAL trial countries are considering programmatic uptake of 6-month, all-oral treatment regimens. We used a Markov model to estimate the incremental cost-effectiveness of three regimens containing bedaquiline, pretomanid and linezolid (BPaL) with and without moxifloxacin (BPaLM) or clofazimine (BPaLC) compared with the current mix of long and short standard of care (SOC) regimens to treat RR-TB from the provider perspective in India, Georgia, Philippines, and South Africa. We estimated total costs (2019 USD) and disability-adjusted life years (DALYs) over a 20-year time horizon. Costs and DALYs were discounted at 3% in the base case. Parameter uncertainty was tested with univariate and probabilistic sensitivity analysis. We found that all three regimens would improve health outcomes and reduce costs compared with the current programmatic mix of long and short SOC regimens in all four countries. BPaL was the most cost-saving regimen in all countries, saving $112-$1,173 per person. BPaLM was the preferred regimen at a willingness to pay per DALY of 0.5 GDP per capita in all settings. Our findings indicate BPaL-based regimens are likely to be cost-saving and more effective than the current standard of care in a range of settings. Countries should consider programmatic uptake of BPaL-based regimens. |
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| AbstractList | Current options for treating tuberculosis (TB) that is resistant to rifampicin (RR-TB) are few, and regimens are often long and poorly tolerated. Following recent evidence from the TB-PRACTECAL trial countries are considering programmatic uptake of 6-month, all-oral treatment regimens. We used a Markov model to estimate the incremental cost-effectiveness of three regimens containing bedaquiline, pretomanid and linezolid (BPaL) with and without moxifloxacin (BPaLM) or clofazimine (BPaLC) compared with the current mix of long and short standard of care (SOC) regimens to treat RR-TB from the provider perspective in India, Georgia, Philippines, and South Africa. We estimated total costs (2019 USD) and disability-adjusted life years (DALYs) over a 20-year time horizon. Costs and DALYs were discounted at 3% in the base case. Parameter uncertainty was tested with univariate and probabilistic sensitivity analysis. We found that all three regimens would improve health outcomes and reduce costs compared with the current programmatic mix of long and short SOC regimens in all four countries. BPaL was the most cost-saving regimen in all countries, saving $112-$1,173 per person. BPaLM was the preferred regimen at a willingness to pay per DALY of 0.5 GDP per capita in all settings. Our findings indicate BPaL-based regimens are likely to be cost-saving and more effective than the current standard of care in a range of settings. Countries should consider programmatic uptake of BPaL-based regimens. Current options for treating tuberculosis (TB) that is resistant to rifampicin (RR-TB) are few, and regimens are often long and poorly tolerated. Following recent evidence from the TB-PRACTECAL trial countries are considering programmatic uptake of 6-month, all-oral treatment regimens. We used a Markov model to estimate the incremental cost-effectiveness of three regimens containing bedaquiline, pretomanid and linezolid (BPaL) with and without moxifloxacin (BPaLM) or clofazimine (BPaLC) compared with the current mix of long and short standard of care (SOC) regimens to treat RR-TB from the provider perspective in India, Georgia, Philippines, and South Africa. We estimated total costs (2019 USD) and disability-adjusted life years (DALYs) over a 20-year time horizon. Costs and DALYs were discounted at 3% in the base case. Parameter uncertainty was tested with univariate and probabilistic sensitivity analysis. We found that all three regimens would improve health outcomes and reduce costs compared with the current programmatic mix of long and short SOC regimens in all four countries. BPaL was the most cost-saving regimen in all countries, saving $112-$1,173 per person. BPaLM was the preferred regimen at a willingness to pay per DALY of 0.5 GDP per capita in all settings. Our findings indicate BPaL-based regimens are likely to be cost-saving and more effective than the current standard of care in a range of settings. Countries should consider programmatic uptake of BPaL-based regimens.Current options for treating tuberculosis (TB) that is resistant to rifampicin (RR-TB) are few, and regimens are often long and poorly tolerated. Following recent evidence from the TB-PRACTECAL trial countries are considering programmatic uptake of 6-month, all-oral treatment regimens. We used a Markov model to estimate the incremental cost-effectiveness of three regimens containing bedaquiline, pretomanid and linezolid (BPaL) with and without moxifloxacin (BPaLM) or clofazimine (BPaLC) compared with the current mix of long and short standard of care (SOC) regimens to treat RR-TB from the provider perspective in India, Georgia, Philippines, and South Africa. We estimated total costs (2019 USD) and disability-adjusted life years (DALYs) over a 20-year time horizon. Costs and DALYs were discounted at 3% in the base case. Parameter uncertainty was tested with univariate and probabilistic sensitivity analysis. We found that all three regimens would improve health outcomes and reduce costs compared with the current programmatic mix of long and short SOC regimens in all four countries. BPaL was the most cost-saving regimen in all countries, saving $112-$1,173 per person. BPaLM was the preferred regimen at a willingness to pay per DALY of 0.5 GDP per capita in all settings. Our findings indicate BPaL-based regimens are likely to be cost-saving and more effective than the current standard of care in a range of settings. Countries should consider programmatic uptake of BPaL-based regimens. |
| Author | Berry, Catherine Sweeney, Sedona Fielding, Katherine Kazounis, Emil Dodd, Matthew Vassall, Anna Nyang’wa, Bern-Thomas Motta, Ilaria |
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| Cites_doi | 10.1111/tmi.12544 10.1183/13993003.00353-2018 10.1016/j.ccm.2019.08.002 10.5588/ijtld.17.0661 10.1056/NEJMoa1901814 10.1016/j.jval.2016.04.015 10.1136/bmjopen-2019-036599 10.1136/bmjgh-2021-007182 10.1136/bmjopen-2021-051521 10.1016/S2213-2600(20)30039-4 |
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| References | B. Nyang’wa (pgph.0001337.ref008) 2021 S Sweeney (pgph.0001337.ref010) 2020; 10 HBM Hilderink (pgph.0001337.ref022) 2016; 74 M Quaife (pgph.0001337.ref021) 2020; 8 C Mulder (pgph.0001337.ref028) 2022 A Babaniyazov (pgph.0001337.ref016) 2016 IF Walker (pgph.0001337.ref019) 2019; 54 National Center for Tuberculosis and Lung Disease (pgph.0001337.ref013) 2019 pgph.0001337.ref020 SR Mase (pgph.0001337.ref003) 2019; 40 T Wilkinson (pgph.0001337.ref023) 2016; 19 S Abidi (pgph.0001337.ref018) 2020 pgph.0001337.ref024 pgph.0001337.ref007 pgph.0001337.ref027 pgph.0001337.ref004 pgph.0001337.ref009 F Mirzayev (pgph.0001337.ref005) 2021 World Health Organization (pgph.0001337.ref002) 2021 K Schnippel (pgph.0001337.ref026) 2018; 22 World Health Organization (pgph.0001337.ref001) 2014 H Cox (pgph.0001337.ref025) 2015; 20 pgph.0001337.ref011 Central TB Division, Central TB Division ND (pgph.0001337.ref012) 2021 C. Berry (pgph.0001337.ref017) 2021 F Conradie (pgph.0001337.ref006) 2020; 382 GB Gomez (pgph.0001337.ref029) 2021; 11 Republic of South Africa Department of Health (pgph.0001337.ref015) 2018 Philippines National Tuberculosis Control Program (pgph.0001337.ref014) 2020 |
| References_xml | – start-page: 19 year: 2021 ident: pgph.0001337.ref008 article-title: TB-PRACTECAL: Trial results and next steps publication-title: Proceedings of the 52nd Union World Conference on Lung Health, Virtual Event – volume: 74 start-page: 1 year: 2016 ident: pgph.0001337.ref022 article-title: Accounting for multimorbidity can affect the estimation of the Burden of Disease: A comparison of approaches publication-title: Arch Public Heal – year: 2019 ident: pgph.0001337.ref013 article-title: National Strategy for Tuberculosis Control in Georgia 2019–2022 publication-title: Tbilisi – volume: 20 start-page: 1337 year: 2015 ident: pgph.0001337.ref025 article-title: Cost per patient of treatment for rifampicin-resistant tuberculosis in a community-based programme in Khayelitsha, South Africa publication-title: Trop Med Int Heal doi: 10.1111/tmi.12544 – ident: pgph.0001337.ref009 – ident: pgph.0001337.ref007 – volume: 54 year: 2019 ident: pgph.0001337.ref019 article-title: Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients publication-title: Eur Respir J doi: 10.1183/13993003.00353-2018 – volume: 40 start-page: 775 year: 2019 ident: pgph.0001337.ref003 article-title: Treatment of drug-resistant tuberculosis publication-title: Clin Chest Med doi: 10.1016/j.ccm.2019.08.002 – volume: 22 start-page: 393 year: 2018 ident: pgph.0001337.ref026 article-title: Direct costs of managing adverse drug reactions during rifampicin-resistant tuberculosis treatment in South Africa publication-title: Int J Tuberc Lung Dis doi: 10.5588/ijtld.17.0661 – volume: 382 start-page: 893 year: 2020 ident: pgph.0001337.ref006 article-title: Treatment of Highly Drug-Resistant Pulmonary Tuberculosis publication-title: N Engl J Med doi: 10.1056/NEJMoa1901814 – ident: pgph.0001337.ref024 – volume: 19 start-page: 921 year: 2016 ident: pgph.0001337.ref023 article-title: The International Decision Support Initiative Reference Case for Economic Evaluation: An Aid to Thought publication-title: Value Heal doi: 10.1016/j.jval.2016.04.015 – volume: 10 start-page: e036599 year: 2020 ident: pgph.0001337.ref010 article-title: Cost-effectiveness of new MDR-TB regimens: study protocol for the TB-PRACTECAL economic evaluation substudy publication-title: BMJ Open doi: 10.1136/bmjopen-2019-036599 – year: 2021 ident: pgph.0001337.ref017 article-title: TB PRACTECAL: Stage 2 efficacy results publication-title: Proceedings of the 52nd Union World Conference on Lung Health, Virtual Event. – ident: pgph.0001337.ref020 – year: 2021 ident: pgph.0001337.ref005 article-title: World health organization recommendations on the treatment of drug-resistant tuberculosis, 2020 update publication-title: European Respiratory Journal – start-page: 1 year: 2018 ident: pgph.0001337.ref015 publication-title: Interim Clinical Guidance for the Implementation of Injectable-Free Regimens for Rifampicin-Resistant Tuberculosis in Adults, Adolescents and Children – start-page: 55 year: 2020 ident: pgph.0001337.ref018 article-title: Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis publication-title: Eur Respir J – year: 2016 ident: pgph.0001337.ref016 article-title: ‘Trial and Error’ operational reflections on the set-up of a community engagement programme for a phase ii/iii clinical trial to identify new MDR-TB treatments in Uzbekistan publication-title: Médecins Sans Frontières Scientific Day South Asia (not peer reviewed) – year: 2022 ident: pgph.0001337.ref028 article-title: Budgetary impact of using BPaL for treating extensively drug- - resistant tuberculosis. doi: 10.1136/bmjgh-2021-007182 – volume: 11 year: 2021 ident: pgph.0001337.ref029 article-title: Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines publication-title: BMJ Open doi: 10.1136/bmjopen-2021-051521 – year: 2021 ident: pgph.0001337.ref012 article-title: Guidelines for programmatic management of drug resistant TB in India 2021. publication-title: New Delhi – ident: pgph.0001337.ref011 – year: 2014 ident: pgph.0001337.ref001 publication-title: Tuberculosis: Fact sheet N°104 – year: 2021 ident: pgph.0001337.ref002 article-title: Global tuberculosis report publication-title: Geneva – ident: pgph.0001337.ref027 – ident: pgph.0001337.ref004 – year: 2020 ident: pgph.0001337.ref014 article-title: Manual of Procedures publication-title: Manila – volume: 8 start-page: 332 year: 2020 ident: pgph.0001337.ref021 article-title: Post-tuberculosis mortality and morbidity: valuing the hidden epidemic publication-title: Lancet Respir Med doi: 10.1016/S2213-2600(20)30039-4 |
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