Cost-utility analysis of high-dose treatment for intermediate-susceptible, dose-dependent tuberculosis patients

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Abstract

SETTING: We proposed to: 1) introduce an intermediate-susceptible, dose-dependent (ISDD) category for Mycobacterium tuberculosis infection; and 2) treat patients with M. tuberculosis infection in this category with a high dose of rifampicin (RMP) and isoniazid (INH).

OBJECTIVE : To examine the impact of our strategy on quality-adjusted life-years (QALY) and costs in a low-income country with a high prevalence of multidrug-resistant tuberculosis (MDR-TB) (Belarus) and a high-income, low MDR-TB prevalence country (The Netherlands).

DESIGN: A Markov model comprising 14 health states was used to simulate treatment outcomes and costs accrued over 5 years for a hypothetical cohort of 10 000 patients. One-way sensitivity analysis, probabilistic sensitivity analysis and a scenario analysis were also performed.

RESULTS : Our strategy was shown to be cost-effective for Belarus, but not for the Netherlands. At a willingness-to-pay of 50 000 euros per QALY, the probability of our strategy being cost-effective was 50% for the Netherlands and 57% for Belarus.

CONCLUSION: The study shows that our strategy could be cost-effective and more efficacious. However, more studies are needed on the outcomes of using higher doses of INH and RMP.

Original languageEnglish
Pages (from-to)991-999
Number of pages10
JournalInternational Journal of Tuberculosis and Lung Disease
Volume22
Issue number9
DOIs
Publication statusPublished - 1-Sep-2018

Keywords

  • cost-effectiveness
  • first-line anti-tuberculosis treatment
  • susceptibility testing
  • high-dose INH and RMP
  • MULTIDRUG-RESISTANT TUBERCULOSIS
  • RANDOMIZED CONTROLLED-TRIAL
  • MYCOBACTERIUM-TUBERCULOSIS
  • ANTITUBERCULOSIS DRUGS
  • PULMONARY TUBERCULOSIS
  • BREAKPOINTS
  • RIFAMPIN
  • THERAPY
  • OPTIMIZE
  • OUTCOMES

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