Mayara Lisboa Bastos1, Jonathon R Campbell2, Olivia Oxlade3, Menonli Adjobimey4, Anete Trajman5, Rovina Ruslami6, Hee Jin Kim7, Joseph Obeng Baah8, Brett G Toelle9, Richard Long10, Vernon Hoeppner11, Kevin Elwood12, Hamdan Al-Jahdali13, Lika Apriani14, Andrea Benedetti2, Kevin Schwartzman2, Dick Menzies2. 1. State University of Rio de Janeiro, Rio de Janeiro, Brazil, and McGill University, Montreal, Quebec, Canada (M.L.B.). 2. McGill University, Montreal, Quebec, Canada (J.R.C., A.B., K.S., D.M.). 3. McGill International TB Center, Montreal, Quebec, Canada (O.O.). 4. Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A.). 5. McGill University, Montreal, Quebec, Canada, and Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (A.T.). 6. Universtitas Padjadjaran, Bandung, Indonesia (R.R.). 7. Korean National Tuberculosis Association, Seoul, South Korea (H.J.K.). 8. Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.). 9. The University of Sydney, Woolcock Institute of Medical Research, and Sydney Local Health District, Sydney, Australia (B.G.T.). 10. University of Alberta, Edmonton, Alberta, Canada (R.L.). 11. University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.H.). 12. BC Centre for Disease Control and University of British Columbia, Vancouver, British Columbia, Canada (K.E.). 13. King Saud University, King Abdulaziz Medical City, Riyadh, Saudi Arabia (H.A.). 14. Universitas Padjadjaran, Bandung, Indonesia (L.A.).
Abstract
BACKGROUND: Four months of rifampin treatment for latent tuberculosis infection is safer, has superior treatment completion rates, and is as effective as 9 months of isoniazid. However, daily medication costs are higher for a 4-month rifampin regimen than a 9-month isoniazid regimen. OBJECTIVE: To compare health care use and associated costs of 4 months of rifampin and 9 months of isoniazid. DESIGN: Health system cost comparison using all health care activities recorded during 2 randomized clinical trials. (ClinicalTrials.gov: NCT00931736 and NCT00170209). SETTING: High-income countries (Australia, Canada, Saudi Arabia, and South Korea), middle-income countries (Brazil and Indonesia), and African countries (Benin, Ghana, and Guinea). PARTICIPANTS: Adults and children with clinical or epidemiologic factors associated with increased risk for developing tuberculosis that warranted treatment for latent tuberculosis infection. MEASUREMENTS: Health system costs per participant. RESULTS: A total of 6012 adults and 829 children were included. In both adults and children, greater health system use and higher costs were observed with 9 months of isoniazid than with 4 months of rifampin. In adults, the ratios of costs of 4 months of rifampin versus 9 months of isoniazid were 0.76 (95% CI, 0.70 to 0.82) in high-income countries, 0.90 (CI, 0.85 to 0.96) in middle-income countries, and 0.80 (CI, 0.78 to 0.81) in African countries. Similar findings were observed in the pediatric population. LIMITATION: Costs may have been overestimated because the trial protocol required a minimum number of follow-up visits, although fewer than recommended by many authoritative guidelines. CONCLUSION: A 4-month rifampin regimen was safer and less expensive than 9 months of isoniazid in all settings. This regimen could be adopted by tuberculosis programs in many countries as first-line therapy for latent tuberculosis infection. PRIMARY FUNDING SOURCE: Canadian Institutes of Health Research.
BACKGROUND: Four months of rifampin treatment for latent tuberculosis infection is safer, has superior treatment completion rates, and is as effective as 9 months of isoniazid. However, daily medication costs are higher for a 4-month rifampin regimen than a 9-month isoniazid regimen. OBJECTIVE: To compare health care use and associated costs of 4 months of rifampin and 9 months of isoniazid. DESIGN: Health system cost comparison using all health care activities recorded during 2 randomized clinical trials. (ClinicalTrials.gov: NCT00931736 and NCT00170209). SETTING: High-income countries (Australia, Canada, Saudi Arabia, and South Korea), middle-income countries (Brazil and Indonesia), and African countries (Benin, Ghana, and Guinea). PARTICIPANTS: Adults and children with clinical or epidemiologic factors associated with increased risk for developing tuberculosis that warranted treatment for latent tuberculosis infection. MEASUREMENTS: Health system costs per participant. RESULTS: A total of 6012 adults and 829 children were included. In both adults and children, greater health system use and higher costs were observed with 9 months of isoniazid than with 4 months of rifampin. In adults, the ratios of costs of 4 months of rifampin versus 9 months of isoniazid were 0.76 (95% CI, 0.70 to 0.82) in high-income countries, 0.90 (CI, 0.85 to 0.96) in middle-income countries, and 0.80 (CI, 0.78 to 0.81) in African countries. Similar findings were observed in the pediatric population. LIMITATION: Costs may have been overestimated because the trial protocol required a minimum number of follow-up visits, although fewer than recommended by many authoritative guidelines. CONCLUSION: A 4-month rifampin regimen was safer and less expensive than 9 months of isoniazid in all settings. This regimen could be adopted by tuberculosis programs in many countries as first-line therapy for latent tuberculosis infection. PRIMARY FUNDING SOURCE: Canadian Institutes of Health Research.
Authors: Mercedes Yanes-Lane; Edgar Ortiz-Brizuela; Jonathon R Campbell; Andrea Benedetti; Gavin Churchyard; Olivia Oxlade; Dick Menzies Journal: PLoS Med Date: 2021-09-14 Impact factor: 11.613
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: L Apriani; R C Koesoemadinata; M L Bastos; D A Wulandari; P Santoso; B Alisjahbana; M E Rutherford; P C Hill; A Benedetti; D Menzies; R Ruslami Journal: Int J Tuberc Lung Dis Date: 2022-02-01 Impact factor: 2.373
Authors: Jonathon R Campbell; Placide Nsengiyumva; Leslie Y Chiang; Frances Jamieson; Hadeel Khadawardi; Henry K-H Mah; Olivia Oxlade; Hayden Rasberry; Elizabeth Rea; Kamila Romanowski; Natasha F Sabur; Beate Sander; Aashna Uppal; James C Johnston; Kevin Schwartzman; Sarah K Brode Journal: Emerg Infect Dis Date: 2022-09 Impact factor: 16.126