Cost-effectiveness of treating multidrug-resistant tuberculosis

Area of Science:

• Global Health
• Infectious Disease Epidemiology
• Health Economics

Background:

• Tuberculosis (TB) remains a major global health threat, causing 2 million deaths annually.
• Multidrug-resistant TB (MDR TB) strains complicate treatment, necessitating the use of expensive second-line drugs.
• Effective and cost-effective strategies are crucial for managing MDR TB, especially in resource-limited settings.

Purpose of the Study:

• To project the health benefits and cost-effectiveness of using drug susceptibility testing and second-line drugs for MDR TB.
• To evaluate various treatment strategies in a lower-middle-income setting with high MDR TB prevalence.
• To compare the economic impact of different approaches to MDR TB management.

Main Methods:

• Development of a dynamic state-transition model of TB.
• Calibration of the model to approximate the TB epidemic in Peru.
• Evaluation of strategies including DOTS, standardized second-line treatment (STR1, STR2), and individualized treatment (ITR1, ITR2).

Main Results:

• Strategies using second-line drug regimens after first-line treatment failure were highly cost-effective.
• Standardized second-line treatment for confirmed MDR TB (STR2) cost $720 per QALY gained.
• Individualized treatment for MDR TB (ITR1) cost $990 per QALY gained, offering more benefit.
• More aggressive individualized treatment (ITR2) cost $11,000 per QALY gained.

Conclusions:

• Treatment of MDR TB with second-line drugs is highly cost-effective in Peru.
• The cost-effectiveness of second-line drug strategies depends on TB incidence, MDR burden, and budget in different settings.
• Simulation results suggest individualized regimens are cost-effective across various scenarios.