Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis

• Published in: BMC infectious diseases Vol. 16; no. 1; p. 726
• Main Authors: Gomez, G B, Dowdy, D W, Bastos, M L, Zwerling, A, Sweeney, S, Foster, N, Trajman, A, Islam, M A, Kapiga, S, Sinanovic, E, Knight, G M, White, R G, Wells, W A, Cobelens, F G, Vassall, A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01-12-2016; BioMed Central
• Subjects: Antitubercular Agents - economics; Bangladesh; Brazil; Care and treatment; Cost-Benefit Analysis; Delivery of Health Care - economics; Drug Costs; Health aspects; Health Care Costs; Health Expenditures; Health Services - economics; Humans; Infectious diseases; Medical care, Cost of; Models, Theoretical; Moxifloxacin; South Africa; Tanzania; Treatment Outcome; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - economics; Tanzania; Tuberculosis; New technologies; Cost-effectiveness; Economic evaluation
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-016-2064-3

Despite improvements in treatment success rates for tuberculosis (TB), current six-month regimen duration remains a challenge for many National TB Programmes, health systems, and patients. There is increasing investment in the development of shortened regimens with a number of candidates in phase 3 trials.
We developed an individual-based decision analytic model to assess the cost-effectiveness of a hypothetical four-month regimen for first-line treatment of TB, assuming non-inferiority to current regimens of six-month duration. The model was populated using extensive, empirically-collected data to estimate the economic impact on both health systems and patients of regimen shortening for first-line TB treatment in South Africa, Brazil, Bangladesh, and Tanzania. We explicitly considered 'real world' constraints such as sub-optimal guideline adherence.
From a societal perspective, a shortened regimen, priced at USD1 per day, could be a cost-saving option in South Africa, Brazil, and Tanzania, but would not be cost-effective in Bangladesh when compared to one gross domestic product (GDP) per capita. Incorporating 'real world' constraints reduces cost-effectiveness. Patient-incurred costs could be reduced in all settings. From a health service perspective, increased drug costs need to be balanced against decreased delivery costs. The new regimen would remain a cost-effective option, when compared to each countries' GDP per capita, even if new drugs cost up to USD7.5 and USD53.8 per day in South Africa and Brazil; this threshold was above USD1 in Tanzania and under USD1 in Bangladesh.
Reducing the duration of first-line TB treatment has the potential for substantial economic gains from a patient perspective. The potential economic gains for health services may also be important, but will be context-specific and dependent on the appropriate pricing of any new regimen.