Muniyandi Malaisamy, Karikalan Nagarajan, Velayutham Banurekha, Rajsekar Kavitha, Padmapriyadarsini Chandrasekaran
ICMR-National Institute for Research in Tuberculosis, Chennai 600031, India.
Department of Health Research, Ministry of Health and Family Welfare, New Delhi 110001, India.
Trop Med Infect Dis. 2022 Oct 8;7(10):288. doi: 10.3390/tropicalmed7100288.
Globally efforts are underway to shorten the existing 6-month tuberculosis (TB) treatment regimen for drug-sensitive patients, which would be equally effective and safe. At present, there is a lack of evidence on the cost implications of a shorter 4-month TB regimen in India. This economic modeling study was conducted in the Indian context with a high TB burden. We used a hybrid economic model comprising of a decision tree and Markov analysis. The study estimated the incremental costs, life years (LYs), and quality-adjusted life years (QALYs) gained by the introduction of a Moxifloxacin-based shorter 4-month treatment regimen for pulmonary TB patients. The outcomes are expressed in incremental cost-effectiveness ratios (ICERs) per QALYs gained. The cost per case to be treated under the 4-month regimen was USD 145.94 whereas for the 6-month regimen it was USD 150.39. A shorter 4-month TB regimen was cost-saving with USD 4.62 per LY and USD 5.29 per QALY. One-way sensitivity analysis revealed that the cost of the drugs for the 4-month regimen, hospitalization cost for adverse drug reactions, and human resources incurred for the 6-month regimen had a higher influence on the ICER. The probability sensitivity analysis highlighted that the joint incremental cost and effectiveness using QALY were less costly and more effective for 67% of the iteration values. The cost-effectiveness acceptability curve highlights that the 4-month regimen was dominant to both patients and the National TB Elimination Programme in India as compared to the 6-month regimen at different cost-effectiveness threshold values.
全球正在努力缩短针对药物敏感型患者现有的6个月结核病治疗方案，且该方案将同样有效和安全。目前，在印度缺乏关于缩短至4个月的结核病治疗方案成本影响的证据。这项经济建模研究是在结核病负担较高的印度背景下进行的。我们使用了一种由决策树和马尔可夫分析组成的混合经济模型。该研究估计了通过为肺结核患者引入基于莫西沙星的缩短至4个月的治疗方案所获得的增量成本、生命年（LYs）和质量调整生命年（QALYs）。结果以每获得一个QALY的增量成本效益比（ICERs）表示。4个月治疗方案下每例治疗成本为145.94美元，而6个月治疗方案为150.39美元。缩短至4个月的结核病治疗方案具有成本节约效益，每生命年节约4.62美元，每质量调整生命年节约5.29美元。单向敏感性分析表明，4个月治疗方案的药物成本、药物不良反应的住院成本以及6个月治疗方案产生的人力资源成本对ICER有更高影响。概率敏感性分析强调，对于67%的迭代值，使用QALY的联合增量成本和效果成本更低且效果更好。成本效益可接受性曲线突出显示，在不同成本效益阈值下，与6个月治疗方案相比，4个月治疗方案对印度的患者和国家结核病消除计划而言均占主导地位。
