Document Detail


Impact of treatment completion, intolerance and adverse events on health system costs in a randomised trial of 4 months rifampin or 9 months isoniazid for latent TB.
MedLine Citation:
PMID:  20627913     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: Treatment for latent tuberculosis infection with isoniazid for 9 months (9INH) has poor completion and serious adverse events, while treatment for 4 months with daily rifampin (4RIF) has significantly higher completion and fewer adverse events. OBJECTIVES: To compare the health system costs of 4RIF and 9INH. METHODS: In a randomised trial conducted in five Canadian centres, one Brazilian and one Saudi Arabian centre, consenting subjects were randomised to receive 4RIF or 9INH. Health system costs were estimated from healthcare utilisation including scheduled and unscheduled visits, investigations and drugs. All activities for all subjects were evaluated using financial information from 2007 from the Montreal Chest Institute. Costs were expressed in Canadian dollars. RESULTS: Total health system cost per patient allocated to 4RIF was $854 compared with $970 for 9INH (p<0.0001). The average cost per patient for the 328 of 420 (78%) who completed 4RIF therapy was $1094 compared with $1625 for the 254 of 427 (60%) completing 9INH (p<0.0001). Costs were modestly increased in patients with minor intolerance and substantially increased if the treating physician stopped treatment because of possible adverse events. Total costs related to management of adverse events with 9INH were $48 142 compared with $25 684 for 4RIF (p=0.008). Using these data, incremental cost-effectiveness analyses showed that 4RIF would be cost saving and prevent more cases within 2 years if efficacy exceeded 74%, and cost saving if efficacy exceeded 65%. CONCLUSIONS: The 4RIF regimen was significantly cheaper per patient completing treatment because of better completion and fewer adverse events.
Authors:
Anne Aspler; Richard Long; Anete Trajman; Marie-Josée Dion; Kamran Khan; Kevin Schwartzman; Dick Menzies
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thorax     Volume:  65     ISSN:  1468-3296     ISO Abbreviation:  Thorax     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-14     Completed Date:  2010-08-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  582-7     Citation Subset:  IM    
Affiliation:
Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Canada.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00170209
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MeSH Terms
Descriptor/Qualifier:
Adult
Antibiotics, Antitubercular / administration & dosage,  adverse effects,  economics*
Brazil
Canada
Cost-Benefit Analysis
Drug Administration Schedule
Drug Costs / statistics & numerical data
Health Care Costs / statistics & numerical data*
Health Services / utilization
Humans
Isoniazid / administration & dosage,  adverse effects,  economics
Latent Tuberculosis / drug therapy*,  economics*
Rifampin / administration & dosage,  adverse effects,  economics*
Saudi Arabia
Grant Support
ID/Acronym/Agency:
MCT 44154//Canadian Institutes of Health Research
Chemical
Reg. No./Substance:
0/Antibiotics, Antitubercular; 13292-46-1/Rifampin; 54-85-3/Isoniazid
Comments/Corrections
Comment In:
Thorax. 2010 Jul;65(7):572-3   [PMID:  20627909 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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