A Systematic Review of Economic Evaluations of Active Tuberculosis Treatments

Abstract

Background: The disease burden of active tuberculosis (TB) is considerable, but systematic reviews of economic evaluations of active TB treatments are scarce.Methods: PubMed, EMBASE, and the Cochrane Library databases were used to search for articles on cost-effectiveness analysis or cost-utility analysis that economically evaluated active TB treatments, which were then systematically reviewed by two independent reviewers. We extracted vital components of the included studies, such as country, population, intervention/comparator, primary outcome, values of outcomes, thresholds, model type, time horizon, and health states included in the model.Results: Seventeen studies were included in this systematic review. Thirteen dealt with interventions of medications, and the remaining four compared care strategies. The Markov model was the most commonly used tool to compare medications, whereas studies on care plans mainly used decision trees. The most commonly used primary outcome was disability-adjusted life years, followed by quality-adjusted life years. For treatment-naïve TB, the 4-month regimen was more cost-effective than the 6-month regimen mainly in low- and middle-income countries. For multidrug-resistant TB, a bedaquiline-based regimen was cost-effective. For multidrug-resistant TB, decentralized care that employed the use of home or mobile devices was more cost-effective than hospital-based centralized care in low- and middle-income countries.Conclusion: New treatment strategies to improve therapeutic outcomes by enhancing treatment adherence, such as regimens with shorter durations (2 or 4 months) and decentralized care, or new anti-TB agents (e.g., bedaquiline) have been suggested as cost-effective interventions for active TB. This review provides information on the economic evaluation of active TB from good-quality studies, thus aiding the future economic evaluation of active TB.

Barriers to Optimal Tuberculosis Treatment Services at Community Health Centers: A Qualitative Study From a High Prevalent Tuberculosis Country

“…Moreover, TB has been one of the top 10 causes of death and the leading cause of death from a single infectious agent worldwide (WHO, 2020). Drug-resistant-TB (DR-TB), a resistance of M.tb to one or more anti-tuberculosis drugs, is reported as the main challenge in TB treatment that significantly impacts the clinical and economic aspects of the patients (Pradipta et al, 2019a(Pradipta et al, , 2019bWHO, 2020;Byun et al, 2021). A global meta-analytical study from our group verified that TB patients previously treated for TB have a higher risk of developing multi-drug-resistant TB (MDR-TB) (Pradipta et al, 2018).…”

A systematic review of economic evaluations of pharmacological treatments for active tuberculosis

“…Thus, we started by conducting a rapid review to identify the most relevant and recent systematic review that aligns with our review protocol to update it. Through this initial stage, we identified that the most recent systematic review of interventions for active TB was the one performed by Byun et al, which identified relevant economic evaluations published until January 1st, 2020 ( 15 ).…”

“…As the scope of Byun et al review covered both pharmacological and non-pharmacological treatment strategies and interventions for active TB, we only focused on its included studies involving pharmacological interventions ( 15 ). We then conducted a systematic search to identify all relevant economic evaluations published after its search cut-off date until June 2022.…”

“…While there have been several past systematic reviews of economic evaluations of treatments for latent TB or both active and latent TB, reviews that focused specifically on active tuberculosis are much rarer ( 13 , 14 ). The most recent review by Byun et al focused on active TB but included both pharmacological and non-pharmacological treatments ( 15 ). Additionally, to our knowledge, no reviews of published HTA reports of active TB treatments have been published so far.…”

Synthesis, antitubercular evaluation, and molecular docking studies of hybrid pyridinium salts derived from isoniazid

“…Mycobacterium tuberculosis ( Mtb ) is one of the lethal infectious pathogens accountable for the leading cause of mortality in developing countries (Behr et al, 2021; Byun et al, 2021; Jaganath et al, 2022; Kaufmann, 2021; Li et al, 2020; Pai et al, 2016). As per the World Health Organization (WHO) global tuberculosis report, in 2022, tuberculosis is accountable for 1.4 million deaths among human immunodeficiency virus (HIV)‐negative people and 0.18 million deaths among HIV‐positive people (World Health Organization, 2022).…”