Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Clin Infect Dis. 2021 Sep 7;73(5):e1135-e1141. doi: 10.1093/cid/ciaa1835.
Successful delivery and completion of tuberculosis preventive treatment are necessary for tuberculosis elimination. Shorter preventive treatment regimens currently have higher medication costs, but patients spend less time in care and are more likely to complete treatment. It is unknown how economic costs of successful delivery differ between longer and shorter regimens in high-tuberculosis-burden settings.
We developed survey instruments to collect costs from program and patient sources, considering costs incurred from when household contacts first entered the health system. We compared the cost per completed course of preventive treatment with either 6 months of daily isoniazid (6H) or 3 months of weekly isoniazid and rifapentine (3HP), delivered by the Indus Health Network tuberculosis program in Karachi, Pakistan, between October 2016 and February 2018.
During this period, 459 individuals initiated 6H and 643 initiated 3HP; 39% and 61% completed treatment, respectively. Considering costs to both the program and care recipients, the cost per completed course was 394 US dollars (USD) for 6H and 333 USD for 3HP. Using a new 2020 price for rifapentine reduced the cost per completed course of 3HP to 290 USD. Under varying assumptions about drug prices and costs incurred by care recipients, the cost per completed course was lower for 3HP in all scenarios, and the largest cost drivers were the salaries of clinical staff.
In a high-burden setting, the cost of successful delivery of 3HP was lower than that of 6H, driven by higher completion.
成功实施结核病预防治疗并完成治疗对于消除结核病至关重要。目前，较短的预防治疗方案的药物费用较高，但患者在治疗期间花费的时间更少，更有可能完成治疗。在结核病负担较高的环境中，成功实施较长和较短方案的经济成本差异尚不清楚。
我们开发了调查工具，从方案和患者两个来源收集成本数据，同时考虑了家庭接触者首次进入卫生系统时所产生的成本。我们比较了在巴基斯坦卡拉奇的 Indus 健康网络结核病项目中，6 个月每日异烟肼（6H）或 3 个月每周异烟肼和利福平（3HP）治疗方案的完成疗程的成本，这两种方案的实施时间为 2016 年 10 月至 2018 年 2 月。
在此期间，459 人开始接受 6H 治疗，643 人开始接受 3HP 治疗；分别有 39%和 61%的人完成了治疗。考虑到方案和患者的成本，完成一个疗程的成本为 6H 方案的 394 美元（USD），3HP 方案的 333 美元。如果采用 2020 年新的利福平价格，3HP 方案的每个疗程的成本将降低至 290 美元。在不同的药物价格假设和患者成本假设下，在所有情况下，3HP 方案的完成疗程的成本都较低，最大的成本驱动因素是临床工作人员的工资。
在高负担环境中，3HP 成功实施的成本低于 6H，这主要是由于更高的完成率所致。
