Cost-Effectiveness of a Shorter Four-Month Tuberculosis Treatment Regimen in India

Abstract

Globally efforts are underway to shorten the existing 6-month tuberculosis (TB) treatment regimen for drug-sensitive patients, which would be equally effective and safe. At present, there is a lack of evidence on the cost implications of a shorter 4-month TB regimen in India. This economic modeling study was conducted in the Indian context with a high TB burden. We used a hybrid economic model comprising of a decision tree and Markov analytics. The study estimated the incremental costs, life-years (LYs), and quality adjusted life years (QALYs) gained by the introduction of a Moxifloxacin-based shorter 4-month treatment regimen for pulmonary TB patients. The outcomes are expressed in incremental cost-effectiveness ratios (ICERs) per QALYs gained. The cost per case to be treated under the 4-month regimen was $145.94 whereas for the 6-month regimen it was $150.39. A shorter 4-month TB regimen was cost-saving with $4.62 per LY and $5.29 per QALY. One-way sensitive analysis revealed that the cost of the drugs for the 4-month regimen, hospitalization cost for adverse drug reaction, and human resources incurred for the 6-month regimen had a higher influence on the ICER. The short-course first-line 4-month TB treatment regimen was found to be cost-saving to both patients and National TB Elimination Programme in India.