| Costs and cost-effectiveness of four treatment regimens for latent tuberculosis infection. | |
| | |
MedLine Citation:
|
PMID: 19299495 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
David P Holland; Gillian D Sanders; Carol D Hamilton; Jason E Stout |
Related Documents
:
|
15486905 - Circumcision in hemophilia: a cost-effective method using a novel device. 9482555 - Cost-identification analysis in oral cavity cancer management. 19586325 - Cost implications of iv versus oral anti-angiogenesis therapies in patients with advanc... 17195085 - Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. 22328565 - No significant change in arterial stiffness in ra after 6 months and 1 year of rituxima... 23235195 - Efficacy and safety of clinical use of etanercept for the treatment of moderate-to-seve... |
Publication Detail:
|
Type: Journal Article; Research Support, N.I.H., Extramural Date: 2009-03-19 |
Journal Detail:
|
Title: American journal of respiratory and critical care medicine Volume: 179 ISSN: 1535-4970 ISO Abbreviation: Am. J. Respir. Crit. Care Med. Publication Date: 2009 Jun |
Date Detail:
|
Created Date: 2009-05-21 Completed Date: 2009-06-23 Revised Date: 2013-06-02 |
Medline Journal Info:
|
Nlm Unique ID: 9421642 Medline TA: Am J Respir Crit Care Med Country: United States |
Other Details:
|
Languages: eng Pagination: 1055-60 Citation Subset: AIM; IM |
Affiliation:
|
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Antitubercular Agents
/
administration & dosage,
economics* Cost-Benefit Analysis Directly Observed Therapy / economics Drug Administration Schedule Drug Therapy, Combination Humans Isoniazid / administration & dosage, economics* Markov Chains Rifampin / administration & dosage, analogs & derivatives, economics* Tuberculosis / drug therapy* |
| Grant Support | |
ID/Acronym/Agency:
|
1-U54 AI057157/AI/NIAID NIH HHS; K01 AI083782/AI/NIAID NIH HHS |
| Chemical | |
Reg. No./Substance:
|
0/Antitubercular Agents; 13292-46-1/Rifampin; 54-85-3/Isoniazid; 61379-65-5/rifapentine |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Distinct mutations in the glycogen debranching enzyme found in glycogen storage disease type III lea...
Next Document: Airway delivery of low-dose miglustat normalizes nasal potential difference in F508del cystic fibros...