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.
Highlights
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
Shortening the treatment regimen from six to four months was projected to reduce patient costs in all settings. These savings are estimated to be highest in Brazil (-30%), South Africa (-25%) and lowest in Bangladesh (-5%), where the delivery of TB services at the community level minimizes patient costs [3]
Examining the costs related to Human immunodeficiency virus (HIV), we found that the introduction of a new shortened first-line regimen for TB does not substantially affect the incremental costs related to antiretroviral treatment (ART) (Additional file 1: Table S7)
Summary
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. Previous efforts to quantify the economic and health impact of shortened regimens have been limited; and these efforts have focused on general analyses that are not specific to any particular setting. While such studies can identify key drivers of cost-effectiveness at a general level, further work is required to characterize the costeffectiveness of new TB regimens at country level [8,9,10,11]. The potential benefits in terms of patient costs are important in the light of the post-2015 global TB target of ensuring that no-one suffers catastrophic expenditures from TB, in the context of Universal Health Coverage
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