Potential long-acting tuberculosis treatment for people with HIV: cost-effectiveness benchmarks

Area of Science:

• Public Health
• Infectious Diseases
• Health Economics

Background:

• Tuberculosis (TB) treatment outcomes in South Africa are hampered by high HIV co-infection rates and patient attrition.
• Long-acting TB drugs offer potential benefits but require careful cost-effectiveness evaluation.

Purpose of the Study:

• To determine scenarios where a long-acting TB treatment is clinically beneficial and cost-effective compared to standard oral treatment for people with HIV in South Africa.
• To analyze the impact of efficacy, cost, and patient disengagement on the cost-effectiveness of long-acting TB treatment.

Main Methods:

• A microsimulation model compared standard-of-care 6-month oral TB treatment (SOC) with a long-acting (LA) regimen (2 months oral therapy + one-time injection).
• Model parameters included efficacy, monthly disengagement rates, TB relapse rates, and total regimen costs.
• Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) < USD 3,000 per year-of-life saved (YLS).

Main Results:

• The LA strategy demonstrated lower all-cause mortality (11.4% vs. 11.6%) and reduced disengagement (12.9% vs. 20.9%) compared to SOC.
• LA was cost-effective in base case simulations at both 24-month (ICER $2,230/YLS) and lifetime horizons (ICER $520/YLS).
• LA remained cost-effective across all evaluated parameter ranges in one-way sensitivity analysis over the lifetime horizon.

Conclusions:

• Long-acting injectable TB treatment can be cost-effective compared to conventional oral therapy under specific conditions.
• Cost-effectiveness is achievable with high efficacy and reasonable costs, particularly when disengagement from standard oral TB treatment is high.