The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis

Abstract

There is increasing interest in future, highly-potent 'pan-TB' regimens against tuberculosis (TB), that may be equally effective in both drug-susceptible and rifampicin-resistant (RR) forms of TB. Taking the example of India, the country with the world's largest burden of TB, we show that adoption of these regimens could be: (i) epidemiologically impactful, and (ii) cost-saving to the national TB programme, even if the regimen itself is more costly than current TB treatment. Mathematical modelling suggests that deployment of a pan-TB regimen in 2022 would reduce the annual incidence of TB in 2030 by 23.9% [95% Bayesian credible intervals [CrI] 17.6-30.8%] if used to treat all TB cases, and by 2.30% [95% CrI 1.57-3.48%] if used to treat only RR-TB. Notably, with a regimen costing less than USD 359 (95% CrI 287-441), treating all diagnosed TB cases with the pan-TB regimen yielded greater cost-savings than treating just those diagnosed with RR-TB. One limitation of our approach is that it does not capture the risk of resistance to the new regimen. We discuss ways in which this risk could be mitigated using modern adherence support mechanisms, as well as drug sensitivity testing at the point of TB diagnosis, to prevent new resistant forms from becoming established. A combination of such approaches would be important for maximising the useful lifetime of any future regimen.

MDR Tuberculosis Treatment

“…This will have the advantage of an easier operational implementation [212]. However, we must recall that the classic exposure was once a "pan-TB" regimen and that new first-line treatment may lead to new profiles of TB resistances [213].…”

Tuberculosis Patients During COVID-19 in India (2020–2023): A Brief State-of-the-art View

“…A considerable rise in TB-related deaths and setbacks in TB control were expected, but disturbingly, early data on TB case notification from India indicated a 70% decrease in case reporting time particularly from 15-20 weeks in 2020 as compared 2019. [5][6][7][8] The review aims to examine the different facets of TB and COVID-19, including how the processes of TB diagnosis were affected during the pandemic.…”

Attitudes of Healthcare Workers about Prevention and Control of Nosocomial Multidrug-Resistant Tuberculosis Infection in Two Top-Ranked Tuberculosis Specialized Public Hospitals of Ethiopia

“…Such forms of TB are both difficult to diagnose and treat. Although MDR-TB accounts for less than 6% of the global TB burden, patient management to treat it still accounts for over a quarter of programmatic spending on TB worldwide [ 6 ]. Although there has been a decrease in TB incidence and mortality in recent years, we are still far from the global TB targets proposed by the WHO in its “End TB” strategy launched in 2015 that aims to reduce the absolute number of TB deaths by 95% and the absolute number of new cases by 90% by 2035 [ 7 ].…”