Knight Gwenan M, Gomez Gabriela B, Dodd Peter J, Dowdy David, Zwerling Alice, Wells William A, Cobelens Frank, Vassall Anna, White Richard G
Centre for Mathematical Modelling of Infectious Diseases, TB Centre, TB Modeling Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2015 Dec 30;10(12):e0145796. doi: 10.1371/journal.pone.0145796. eCollection 2015.
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.
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.
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).
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.
结核病（TB）的4个月一线治疗方案预计会对患者预后和社会成本产生直接影响，同时对结核分枝杆菌传播产生间接影响。我们旨在评估在结核病负担较高的国家——南非，这种综合影响。
使用标准的结核病自然史框架，将基于个体的结核分枝杆菌传播模型与南非的结核病负担进行拟合。我们测量了2015年至2035年引入非劣效性4个月治疗方案替代标准6个月治疗方案作为一线治疗对结核病负担的影响。针对三个不同基线（指南、政策和当前）测量影响，反映结核病和艾滋病治疗指南依从性的差异。进一步的情景分析考虑了治疗相关参数和耐药水平的变化。以结核病负担差异和避免的伤残调整生命年（DALYs）来衡量影响。我们还研究了新方案在几个支付意愿阈值下具有成本效益的最高成本。
据估计，在2015年至2035年期间，4个月治疗方案将避免南非预计的600万人年结核病中的不到1%。对死亡和避免的DALYs也有类似的微小影响。尽管影响较小，但随着治疗方案缩短带来的卫生系统和患者成本节省，在支付意愿阈值为人均国内生产总值（GDP）（6618美元）的情况下，4个月治疗方案每月436美元[无，5983]（均值[范围]）可能具有成本效益。
在南非引入非劣效性4个月一线结核病治疗方案对结核病负担影响不大。然而，在几种情景下，避免的社会成本可能使该方案在南非具有成本效益。
