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

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dc.contributor.authorGomez, G B
dc.contributor.authorDowdy, D W
dc.contributor.authorBastos, M L
dc.contributor.authorZwerling, A
dc.contributor.authorSweeney, S
dc.contributor.authorFoster, N
dc.contributor.authorTrajman, A
dc.contributor.authorIslam, M A
dc.contributor.authorKapiga, S
dc.contributor.authorSinanovic, E
dc.contributor.authorKnight, G M
dc.contributor.authorWhite, R G
dc.contributor.authorWells, W A
dc.contributor.authorCobelens, F G
dc.contributor.authorVassall, A
dc.date.accessioned2021-10-08T06:20:27Z
dc.date.available2021-10-08T06:20:27Z
dc.date.issued2016
dc.description.abstractBackground Despite 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. Methods We 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. Results From 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. Conclusion Reducing 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.
dc.identifier.apacitationGomez, G. B., Dowdy, D. W., Bastos, M. L., Zwerling, A., Sweeney, S., Foster, N., ... Vassall, A. (2016). Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis. <i>BMC Infectious Diseases</i>, 16(1), 174 - 177. http://hdl.handle.net/11427/34282en_ZA
dc.identifier.chicagocitationGomez, G B, D W Dowdy, M L Bastos, A Zwerling, S Sweeney, N Foster, A Trajman, et al "Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis." <i>BMC Infectious Diseases</i> 16, 1. (2016): 174 - 177. http://hdl.handle.net/11427/34282en_ZA
dc.identifier.citationGomez, G.B., Dowdy, D.W., Bastos, M.L., Zwerling, A., Sweeney, S., Foster, N., Trajman, A. & Islam, M.A. et al. 2016. Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis. <i>BMC Infectious Diseases.</i> 16(1):174 - 177. http://hdl.handle.net/11427/34282en_ZA
dc.identifier.issn1471-2334
dc.identifier.ris TY - Journal Article AU - Gomez, G B AU - Dowdy, D W AU - Bastos, M L AU - Zwerling, A AU - Sweeney, S AU - Foster, N AU - Trajman, A AU - Islam, M A AU - Kapiga, S AU - Sinanovic, E AU - Knight, G M AU - White, R G AU - Wells, W A AU - Cobelens, F G AU - Vassall, A AB - Background Despite 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. Methods We 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. Results From 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. Conclusion Reducing 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. DA - 2016 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PY - 2016 SM - 1471-2334 T1 - Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis TI - Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis UR - http://hdl.handle.net/11427/34282 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34282
dc.identifier.vancouvercitationGomez GB, Dowdy DW, Bastos ML, Zwerling A, Sweeney S, Foster N, et al. Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis. BMC Infectious Diseases. 2016;16(1):174 - 177. http://hdl.handle.net/11427/34282.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Psychiatry and Mental Health
dc.publisher.facultyFaculty of Health Sciences
dc.sourceBMC Infectious Diseases
dc.source.journalissue1
dc.source.journalvolume16
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12879-016-2064-3
dc.subject.otherCost-effectiveness
dc.subject.otherEconomic evaluation
dc.subject.otherNew technologies
dc.subject.otherTuberculosis
dc.subject.otherAntitubercular Agents
dc.subject.otherBangladesh
dc.subject.otherBrazil
dc.subject.otherCost-Benefit Analysis
dc.subject.otherDelivery of Health Care
dc.subject.otherDrug Costs
dc.subject.otherHealth Care Costs
dc.subject.otherHealth Expenditures
dc.subject.otherHealth Services
dc.subject.otherHumans
dc.subject.otherModels, Theoretical
dc.subject.otherSouth Africa
dc.subject.otherTanzania
dc.subject.otherTreatment Outcome
dc.subject.otherTuberculosis
dc.subject.otherAntitubercular Agents
dc.titleCost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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