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Costs and cost-effectiveness of four treatment regimens for latent tuberculosis infection.

Publication ,  Journal Article
Holland, DP; Sanders, GD; Hamilton, CD; Stout, JE
Published in: Am J Respir Crit Care Med
June 1, 2009

RATIONALE: Isoniazid given daily for 9 months is the standard treatment for latent tuberculosis infection (LTBI), but its effectiveness is limited by poor completion rates. Shorter course regimens and regimens using directly observed therapy result in improved adherence but have higher upfront costs. OBJECTIVES: To evaluate the costs and cost-effectiveness of regimens for the treatment of LTBI. METHODS: We used a computerized Markov model to estimate total societal costs and benefits associated with four regimens for the treatment of LTBI: self-administered isoniazid daily for 9 months, directly observed isoniazid twice-weekly for 9 months, directly observed isoniazid plus rifapentine once weekly for 3 months, and self-administered rifampin daily for 4 months. In the base-case analysis, subjects were assumed to have newly positive tuberculin skin tests after recent exposure to infectious tuberculosis. MEASUREMENTS AND MAIN RESULTS: We determined the costs of treatment, quality-adjusted life-years gained, and cases of active tuberculosis prevented. In the base-case analysis, rifampin dominated (less costly with increased benefits) all other regimens except isoniazid plus rifapentine, which was more effective at a cost $48,997 per quality-adjusted life year gained. Isoniazid plus rifapentine dominated all regimens at a relative risk of disease 5.2 times the baseline estimate, or with completion rates less than 34% for isoniazid or 37% for rifampin. Rifampin could be 17% less efficacious than self-administered isoniazid and still be cost-saving compared with this regimen. CONCLUSIONS: In our model, rifampin is cost-saving compared with the standard therapy of self-administered isoniazid. Isoniazid plus rifapentine is cost-saving for extremely high-risk patients and is cost-effective for lower-risk patients.

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Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

June 1, 2009

Volume

179

Issue

11

Start / End Page

1055 / 1060

Location

United States

Related Subject Headings

  • Tuberculosis
  • Rifampin
  • Respiratory System
  • Markov Chains
  • Isoniazid
  • Humans
  • Drug Therapy, Combination
  • Drug Administration Schedule
  • Directly Observed Therapy
  • Cost-Benefit Analysis
 

Citation

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Holland, D. P., Sanders, G. D., Hamilton, C. D., & Stout, J. E. (2009). Costs and cost-effectiveness of four treatment regimens for latent tuberculosis infection. Am J Respir Crit Care Med, 179(11), 1055–1060. https://doi.org/10.1164/rccm.200901-0153OC
Holland, David P., Gillian D. Sanders, Carol D. Hamilton, and Jason E. Stout. “Costs and cost-effectiveness of four treatment regimens for latent tuberculosis infection.Am J Respir Crit Care Med 179, no. 11 (June 1, 2009): 1055–60. https://doi.org/10.1164/rccm.200901-0153OC.
Holland DP, Sanders GD, Hamilton CD, Stout JE. Costs and cost-effectiveness of four treatment regimens for latent tuberculosis infection. Am J Respir Crit Care Med. 2009 Jun 1;179(11):1055–60.
Holland, David P., et al. “Costs and cost-effectiveness of four treatment regimens for latent tuberculosis infection.Am J Respir Crit Care Med, vol. 179, no. 11, June 2009, pp. 1055–60. Pubmed, doi:10.1164/rccm.200901-0153OC.
Holland DP, Sanders GD, Hamilton CD, Stout JE. Costs and cost-effectiveness of four treatment regimens for latent tuberculosis infection. Am J Respir Crit Care Med. 2009 Jun 1;179(11):1055–1060.

Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

June 1, 2009

Volume

179

Issue

11

Start / End Page

1055 / 1060

Location

United States

Related Subject Headings

  • Tuberculosis
  • Rifampin
  • Respiratory System
  • Markov Chains
  • Isoniazid
  • Humans
  • Drug Therapy, Combination
  • Drug Administration Schedule
  • Directly Observed Therapy
  • Cost-Benefit Analysis