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The Impact and Cost-Effectiveness of a Four-Month Regimen for First-Line Treatment of Active Tuberculosis in South Africa

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Listed:
  • Gwenan M Knight
  • Gabriela B Gomez
  • Peter J Dodd
  • David Dowdy
  • Alice Zwerling
  • William A Wells
  • Frank Cobelens
  • Anna Vassall
  • Richard G White

Abstract

Background: A 4-month first-line treatment regimen for tuberculosis disease (TB) is expected to have a direct impact on patient outcomes and societal costs, as well as an indirect impact on Mycobacterium tuberculosis transmission. We aimed to estimate this combined impact in a high TB-burden country: South Africa. Method: An individual based M. tb transmission model was fitted to the TB burden of South Africa using a standard TB natural history framework. We measured the impact on TB burden from 2015–2035 of introduction of a non-inferior 4-month regimen replacing the standard 6-month regimen as first-line therapy. Impact was measured with respect to three separate baselines (Guidelines, Policy and Current), reflecting differences in adherence to TB and HIV treatment guidelines. Further scenario analyses considered the variation in treatment-related parameters and resistance levels. Impact was measured in terms of differences in TB burden and Disability Adjusted Life Years (DALYs) averted. We also examined the highest cost at which the new regimen would be cost-effective for several willingness-to-pay thresholds. Results: It was estimated that a 4-month regimen would avert less than 1% of the predicted 6 million person years with TB disease in South Africa between 2015 and 2035. A similarly small impact was seen on deaths and DALYs averted. Despite this small impact, with the health systems and patient cost savings from regimen shortening, the 4-month regimen could be cost-effective at $436 [NA, 5983] (mean [range]) per month at a willingness-to-pay threshold of one GDP per capita ($6,618). Conclusion: The introduction of a non-inferior 4-month first-line TB regimen into South Africa would have little impact on the TB burden. However, under several scenarios, it is likely that the averted societal costs would make such a regimen cost-effective in South Africa.

Suggested Citation

  • Gwenan M Knight & Gabriela B Gomez & Peter J Dodd & David Dowdy & Alice Zwerling & William A Wells & Frank Cobelens & Anna Vassall & Richard G White, 2015. "The Impact and Cost-Effectiveness of a Four-Month Regimen for First-Line Treatment of Active Tuberculosis in South Africa," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-13, December.
    • Handle: RePEc:plo:pone00:0145796
    DOI: 10.1371/journal.pone.0145796
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    References listed on IDEAS

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    1. Samuel Shillcutt & Damian Walker & Catherine Goodman & Anne Mills, 2009. "Cost Effectiveness in Low- and Middle-Income Countries," PharmacoEconomics, Springer, vol. 27(11), pages 903-917, November.
    2. Jamison, D.T. & Mosley, W.H., 1991. "Disease control priorities in developing countries: Health policy responses to epidemiological change," American Journal of Public Health, American Public Health Association, vol. 81(1), pages 15-22.
    3. Foster, Nicola & Vassall, Anna & Cleary, Susan & Cunnama, Lucy & Churchyard, Gavin & Sinanovic, Edina, 2015. "The economic burden of TB diagnosis and treatment in South Africa," Social Science & Medicine, Elsevier, vol. 130(C), pages 42-50.
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