Division of Tuberculosis Elimination, National Center for HIV/AIDS, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA; Steven M Teutsch Prevention Effectiveness Fellowship Program, Office of Surveillance, Epidemiology and Laboratory Sciences, CDC, Atlanta, Georgia, USA; Department of Mathematics and Statistics, Mount Holyoke College, South Hadley, Massachusetts, USA.
Int J Tuberc Lung Dis. 2013 Dec;17(12):1531-7. doi: 10.5588/ijtld.13.0423.
A large randomized controlled trial recently showed that for treating latent tuberculous infection (LTBI) in persons at high risk of progression to tuberculosis (TB) disease, a 12-dose regimen of weekly rifapentine plus isoniazid (3HP) administered as directly observed treatment (DOT) can be as effective as 9 months of daily self-administered isoniazid (9H).
To assess the cost-effectiveness of 3HP compared to 9H.
A computational model was designed to simulate individuals with LTBI treated with 9H or 3HP. Costs and health outcomes were estimated to determine the incremental costs per active TB case prevented and per quality-adjusted life year (QALY) gained by 3HP compared to 9H.
Over a 20-year period, treatment of LTBI with 3HP rather than 9H resulted in 5.2 fewer cases of TB and 25 fewer lost QALYs per 1000 individuals treated. From the health system and societal perspectives, 3HP would cost respectively US$21,525 and $4294 more per TB case prevented, and respectively $4565 and $911 more per QALY gained.
3HP may be a cost-effective alternative to 9H, particularly if the cost of rifapentine decreases, the effectiveness of 3HP can be maintained without DOT, and 3HP treatment is limited to those with a high risk of progression to TB disease.
一项大型随机对照试验最近表明，对于治疗潜伏性结核感染（LTBI）高危人群进展为结核病（TB）的风险，每周利福平加异烟肼（3HP）12 剂量方案作为直接观察治疗（DOT）与每日自我管理异烟肼（9H）9 个月一样有效。
评估 3HP 与 9H 相比的成本效益。
设计了一种计算模型来模拟接受 9H 或 3HP 治疗的 LTBI 个体。估计成本和健康结果，以确定与 9H 相比，3HP 每预防 1 例活动性 TB 病例和每获得 1 个质量调整生命年（QALY）的增量成本。
在 20 年期间，用 3HP 治疗 LTBI 比用 9H 治疗导致每 1000 名治疗者少 5.2 例 TB 和少 25 个 QALY。从卫生系统和社会角度来看，3HP 每预防 1 例 TB 病例分别多花费 21525 美元和 4294 美元，每获得 1 个 QALY 分别多花费 4565 美元和 911 美元。
3HP 可能是 9H 的一种具有成本效益的替代方案，特别是如果利福平的成本降低，3HP 的有效性可以在没有 DOT 的情况下保持，并且 3HP 治疗仅限于进展为 TB 疾病风险较高的人群。
