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Potential economic viability of two proposed rifapentine-based regimens for treatment of latent tuberculosis infection.

AbstractRATIONALE:
Rifapentine-based regimens for treating latent tuberculosis infection (LTBI) are being considered for future clinical trials, but even if they prove effective, high drug costs may limit their economic viability.
OBJECTIVES:
To inform clinical trial design by estimating the potential costs and effectiveness of rifapentine-based regimens for treatment of latent tuberculosis infection (LTBI).
METHODS:
We used a Markov model to estimate cost and societal benefits for three regimens for treating LTBI: Isoniazid/rifapentine daily for one month, isoniazid/rifapentine weekly for three months (self-administered and directly-observed), and isoniazid daily for nine months; a strategy of "no treatment" used for comparison. Costs, quality-adjusted life-years gained, and instances of active tuberculosis averted were calculated for all arms.
RESULTS:
Both daily isoniazid/rifapentine for one month and weekly isoniazid/rifapentine for three months were less expensive and more effective than other strategies under a wide variety of clinically plausibly parameter estimates. Daily isoniazid/rifapentine for one month was the least expensive and most effective regimen.
CONCLUSIONS:
Daily isoniazid/rifapentine for one month and weekly isoniazid/rifapentine for three months should be studied in a large-scale clinical trial for efficacy. Because both regimens performed well even if their efficacy is somewhat reduced, study designers should consider relaxing non-inferiority boundaries.
AuthorsDavid P Holland, Gillian D Sanders, Carol D Hamilton, Jason E Stout
JournalPloS one (PLoS One) Vol. 6 Issue 7 Pg. e22276 ( 2011) ISSN: 1932-6203 [Electronic] United States
PMID21789248 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
Chemical References
  • Antitubercular Agents
  • Isoniazid
  • Rifampin
  • rifapentine
Topics
  • Antitubercular Agents (administration & dosage, economics, therapeutic use)
  • Cost-Benefit Analysis
  • Drug Administration Schedule
  • Humans
  • Isoniazid (administration & dosage, economics, therapeutic use)
  • Latent Tuberculosis (drug therapy, economics)
  • Models, Biological
  • Patient Compliance
  • Rifampin (administration & dosage, analogs & derivatives, economics, therapeutic use)
  • Self Administration
  • United States

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