Gregory J Fox1,2, Olivia Oxlade1,2, Dick Menzies1,2. 1. 1 Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada; and. 2. 2 McGill International TB Centre, Montreal, Quebec, Canada.
Abstract
RATIONALE: Fluoroquinolone (FQN) therapy of latent tuberculosis infection among contacts of individuals with multidrug-resistant tuberculosis (MDR-TB) is controversial. OBJECTIVES: To determine the potential benefits, risks (including acquired FQN resistance), and cost-effectiveness of FQN therapy to prevent TB in contacts of individuals with MDR-TB. METHODS: We used decision analysis to estimate costs and outcomes associated with no therapy compared with a 6-month course of daily FQN therapy to treat latent TB infection in contacts of individuals with MDR-TB. Outcomes modeled were the incidence of MDR-TB, MDR-TB with FQN resistance, TB-related death, quality-adjusted life years, and health system costs. MEASUREMENTS AND MAIN RESULTS: FQN preventive therapy resulted in health system savings, lower incidence of MDR-TB, and lower mortality than no treatment. We found the incidence of MDR-TB with acquired FQN resistance would also be lower with FQN therapy of infected contacts. CONCLUSIONS: In our model, FQN preventive therapy resulted in substantial health system savings and in reduced mortality, incidence of MDR-TB, and incidence of acquired FQN-resistant disease as well as improved quality of life. FQN therapy remained cost saving with improved outcomes even if the effectiveness of therapy in preventing MDR-TB was as low as 10%.
RATIONALE: Fluoroquinolone (FQN) therapy of latent tuberculosis infection among contacts of individuals with multidrug-resistant tuberculosis (MDR-TB) is controversial. OBJECTIVES: To determine the potential benefits, risks (including acquired FQN resistance), and cost-effectiveness of FQN therapy to prevent TB in contacts of individuals with MDR-TB. METHODS: We used decision analysis to estimate costs and outcomes associated with no therapy compared with a 6-month course of daily FQN therapy to treat latent TB infection in contacts of individuals with MDR-TB. Outcomes modeled were the incidence of MDR-TB, MDR-TB with FQN resistance, TB-related death, quality-adjusted life years, and health system costs. MEASUREMENTS AND MAIN RESULTS: FQN preventive therapy resulted in health system savings, lower incidence of MDR-TB, and lower mortality than no treatment. We found the incidence of MDR-TB with acquired FQN resistance would also be lower with FQN therapy of infected contacts. CONCLUSIONS: In our model, FQN preventive therapy resulted in substantial health system savings and in reduced mortality, incidence of MDR-TB, and incidence of acquired FQN-resistant disease as well as improved quality of life. FQN therapy remained cost saving with improved outcomes even if the effectiveness of therapy in preventing MDR-TB was as low as 10%.
Authors: Peter J Dodd; Nyashadzaishe Mafirakureva; James A Seddon; Christopher F McQuaid Journal: Lancet Glob Health Date: 2022-05-18 Impact factor: 38.927
Authors: Emily A Kendall; Hamidah Hussain; Amber Kunkel; Rachel W Kubiak; Anete Trajman; Richard Menzies; Paul K Drain Journal: BMC Med Date: 2021-12-14 Impact factor: 11.150
Authors: Mikaela Coleman; Jeremy Hill; Eretii Timeon; Alfred Tonganibeia; Baraniko Eromanga; Tauhid Islam; James M Trauer; Stephen T Chambers; Amanda Christensen; Greg J Fox; Guy B Marks; Warwick J Britton; Ben J Marais Journal: BMJ Open Date: 2022-04-12 Impact factor: 2.692
Authors: Greg J Fox; Cam Binh Nguyen; Thu Anh Nguyen; Phuong Thuy Tran; Ben J Marais; Steve M Graham; Binh Hoa Nguyen; Kavi Velen; David W Dowdy; Paul Mason; Warwick J Britton; Marcel A Behr; Andrea Benedetti; Dick Menzies; Viet Nhung Nguyen; Guy B Marks Journal: BMJ Open Date: 2020-01-02 Impact factor: 2.692