Cost-effectiveness of a 12-dose regimen for treating latent tuberculous infection in the United States

Abstract

SUMMARY SETTING A large randomized controlled trial recently showed that for treating latent tuberculous infection (LTBI) in persons at high risk of progression to tuberculosis (TB) disease, a 12-dose regimen of weekly rifapentine plus isoniazid (3HP) administered as directly observed treatment (DOT) can be as effective as 9 months of daily self-administered isoniazid (9H). OBJECTIVES To assess the cost-effectiveness of 3HP compared to 9H. DESIGN A computational model was designed to simulate individuals with LTBI treated with 9H or 3HP. Costs and health outcomes were estimated to determine the incremental costs per active TB case prevented and per quality-adjusted life year (QALY) gained by 3HP compared to 9H. RESULTS Over a 20-year period, treatment of LTBI with 3HP rather than 9H resulted in 5.2 fewer cases of TB and 25 fewer lost QALYs per 1000 individuals treated. From the health system and societal perspectives, 3HP would cost respectively US$21 525 and $4294 more per TB case prevented, and respectively $4565 and $911 more per QALY gained. CONCLUSIONS 3HP may be a cost-effective alternative to 9H, particularly if the cost of rifapentine decreases, the effectiveness of 3HP can be maintained without DOT, and 3HP treatment is limited to those with a high risk of progression to TB disease.

Estimating tuberculosis cases and their economic costs averted in the United States over the past two decades

“…In-patient and out-patient direct costs in 2010 dollars of non-MDR-TB reported and methods described in Shepardson et al, 17 were updated to 2014 dollars by using the Consumer Price Index for Medical Care. 18 Direct costs in 2010 dollars of MDR- and XDR-TB were similarly updated to 2014 dollars.…”

“…Productivity losses due to premature deaths, 21 * updated to 2014 US dollars using the change in average hourly earnings, were estimated at US$24 214 for non-MDR-TB patients (US$373 671 with death at age 65 × 6.48% of patients having deaths caused by TB) and at US$64 153 for XDR-TB patients (US$926 653 with death at age of 55, the average age at death for MDR-TB patients 19 multiplied by 6.92% of patients having deaths caused by TB—the actual percentage in the published MDR-TB patient sample). 19 These costs were added to the societal costs for non-MDR-TB 17 and for XDR-TB. 19 Societal costs, including premature deaths for MDR-TB, were calculated at the individual age at death of patients.…”

A shorter treatment regimen for latent tuberculosis infection holds promise for at-risk Canadians

“…A 2013 cost-effectiveness analysis in the United States found that over 20 years 3HP cost an additional US$4,294 to $21,525 per TB case prevented and an additional US$911 to $4,565 per quality-adjusted life year than INH9 (33). However, an update incorporating new, lower prices for rifapentine substantially altered this evaluation and, in fact, demonstrated cost savings compared to the price of INH9 (34).…”

Activism on rifapentine pricing: removing cost barriers to improve the uptake of tuberculosis research innovations

“…These survey results, along with several articles describing the cost-effectiveness of the 3HP regimen for the treatment of LTBI -especially if costs were lowered-provided a supporting evidence base for the ongoing campaign. [15][16][17] The Community Research Advisors Group (CRAG), an independent advisory body to the TBTC, also harnessed this evidence to encourage Sanofi US to lower the price of RPT, particularly given the public sector investment in the drug to date. In addition to holding in-person meetings with company representatives, and submitting a closed letter, advocates sent two open letters to Sanofi US, communicating formal requests to lower the price of RPT and commit to further funding for TB research.…”