Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis

Abstract

BackgroundDespite improvements in treatment success rates for tuberculosis (TB), current six-month regimen duration remains a challenge for many National TB Programmes, health systems, and patients. There is increasing investment in the development of shortened regimens with a number of candidates in phase 3 trials.MethodsWe developed an individual-based decision analytic model to assess the cost-effectiveness of a hypothetical four-month regimen for first-line treatment of TB, assuming non-inferiority to current regimens of six-month duration. The model was populated using extensive, empirically-collected data to estimate the economic impact on both health systems and patients of regimen shortening for first-line TB treatment in South Africa, Brazil, Bangladesh, and Tanzania. We explicitly considered ‘real world’ constraints such as sub-optimal guideline adherence.ResultsFrom a societal perspective, a shortened regimen, priced at USD1 per day, could be a cost-saving option in South Africa, Brazil, and Tanzania, but would not be cost-effective in Bangladesh when compared to one gross domestic product (GDP) per capita. Incorporating ‘real world’ constraints reduces cost-effectiveness. Patient-incurred costs could be reduced in all settings. From a health service perspective, increased drug costs need to be balanced against decreased delivery costs. The new regimen would remain a cost-effective option, when compared to each countries’ GDP per capita, even if new drugs cost up to USD7.5 and USD53.8 per day in South Africa and Brazil; this threshold was above USD1 in Tanzania and under USD1 in Bangladesh.ConclusionReducing the duration of first-line TB treatment has the potential for substantial economic gains from a patient perspective. The potential economic gains for health services may also be important, but will be context-specific and dependent on the appropriate pricing of any new regimen.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2064-3) contains supplementary material, which is available to authorized users.

Host Directed Therapies for Tuberculosis: Futures Strategies for an Ancient Disease

“…These limitations emphasize the need and urgency for the development of new treatments primarily for the management of drug-resistant TB, although improved regimens against drug-susceptible TB aimed at reducing toxicity and duration of the current combination therapy are also needed to reduce the risk for the emergence of drug-resistance [5]. In the last few years, thanks to a better understanding of TB pathogenesis and the characterization of the immunological mediators involved, innovative and potentially highly rewarding approaches have been proposed as host-directed therapies (HDTs) that can be used as adjunct to antibiotic-based anti-TB treatment.…”

Managing Uncertainties Due to Limited Evidence in Economic Evaluations of Novel Anti-Tuberculosis Regimens: A Systematic Review

“…Further exclusion based on the full text was performed on five other studies. A total of four studies fulfilled the inclusion criteria and were included [17][18][19][20].…”

“…Three of the included studies were model-based economic evaluations [17][18][19], while one was an empirical study based on publicly available and local data [20]. Two of the modelbased studies used a decision analytic model, which did not take into account TB transmission process (i.e., a static model) [17,18]. One study did not specify the type of static model used [17], while another used a decision tree model [18].…”

Market-driven, value-based, advance commitment (MVAC): accelerating the development of a pathbreaking universal drug regimen to end TB

“…For the MVAC, we propose to merge these two applications of HTA. We used well-validated TB epidemiology and health economic models 21 to predict the likely value of a TB regimen in a sample of high-burden countries; this value assessment serves as the starting point for a price and volume commitment. Our HTA model is based on local country affordability thresholds, calibrated against future budgets; we also imagine a scenario where many new TB technologies (eg, TB vaccines, short regimens, new diagnostic tests) and policies (eg, aggressive private sector engagement in TB treatment in India) will be introduced, inflecting the comparator standard of care and therefore the value of the breakthrough regimen…”