Completion Rates, Adverse Effects, and Costs of a 3-Month and 9-Month Treatment Regimen for Latent Tuberculosis Infection in California Inmates, 2011-2014

Abstract

Objectives: In California, about 80% of tuberculosis disease is caused by untreated latent tuberculosis infection (LTBI), and the rate of LTBI is higher among incarcerated persons (16%) than among nonincarcerated persons (6%). We compared 2 regimens to treat LTBI in an adult prison population in California: 9 months of twice-weekly isoniazid (9H; previous standard of care) and 12 once-weekly doses of isoniazid and rifapentine (3HP; introduced in 2011). Methods: We evaluated the rates of completion and discontinuation caused by hepatotoxicity among randomly selected patients with LTBI prescribed the 9H regimen in 2011 and among patients with LTBI prescribed the 3HP regimen who entered California prisons during September 2013-March 2014. We compared the cost per fully treated patient for the 2 regimens. Results: Of 92 patients treated with the 9H regimen, the treatment completion rate was 42% and discontinuation due to hepatotoxicity was 14%. Of 122 patients who accepted the 3HP regimen, the completion rate was 90% and discontinuation due to hepatotoxicity was 2%. The cost per fully treated patient for the 9H regimen was $981 and for 3HP was $652. Conclusions: In an incarcerated population, the 3HP regimen had a higher completion rate, lower hepatotoxicity, and lower cost per fully treated patient than the 9H regimen. If coupled with a high treatment initiation rate, the high rate of LTBI treatment completion with 3HP may contribute to reducing tuberculosis morbidity in California.

Safety and treatment completion of latent tuberculosis infection treatment in the elderly population—A prospective observational study in Taiwan

“…preventive effect (Njie et al, 2018;Sterling et al, 2011;Sun et al, 2018;Wheeler and Mohle-Boetani, 2019). Meanwhile, previous studies have suggested an increased incidence of systemic drug reactions, especially flu-like symptoms, in patients treated with the 3HP regimen (Sandul et al, 2017;Sterling et al, 2015;Sun et al, 2018).…”

Cost-effectiveness of 3-months isoniazid and rifapentine compared to 9-months isoniazid for latent tuberculosis infection: a systematic review

“…All 3 costing studies reported completion rates, and consistently reported improved completion rates [ 25 – 27 ] for 3HP compared to 9H (See Table 2 ).…”

“…Two are from hospitals in Taiwan [25,26], where DOPT is the standard of care. The other pertains to Californian prisoners [27]. All 3 costing studies reported completion rates, and consistently reported improved completion rates [25][26][27] for 3HP compared to 9H (See Table 2).…”

“…The quality of the included studies, assessed on a modified Drummond checklist [22], is provided in Additional file 4. Of note, the costing studies [25][26][27] do not include all the costs incurred, particularly long-term, downstream costs/savings. They also do not include sensitivity analyses.…”

Understanding and Addressing Health Disparities and Health Needs of Justice-Involved Populations

“…Although the workshop supported a preliminary discussion centered on population health data collection, the articles in this supplement explore data and other issues in depth, providing additional information about incarceration-related health effects and proposing policies and interventions to address associated health disparities. For example, Wheeler and Mohle-Boetani 26 describe the effectiveness of a demonstration project that aims to treat tuberculosis within the correctional system, Massoglia and Remster 27 review the literature on linkages between incarceration and health outcomes, and Wise et al 28 examine the history of incarceration and HIV-related risk behaviors.…”