Cost-effectiveness Analysis of 3 Months of Weekly Rifapentine and Isoniazid Compared to Isoniazid Monotherapy in a Canadian Arctic Setting

Overview

Journal BMJ Open

Specialty General Medicine

Date 2021 May 14

PMID 33986067

Citations 6

Authors

Christopher Pease

Gonzalo Alvarez

Ranjeeta Mallick

Mike Patterson

Sandy Finn

Yahya Habis

Kevin Schwartzman

Elaine Kilabuk

Sunita Mulpuru

Alice Zwerling

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the cost effectiveness of once weekly rifapentine and isoniazid for 12 weeks (3HP) to the current standard care for latent tuberculosis (TB) infection (LTBI) in Iqaluit, Nunavut.

Design: A cost-effectiveness analysis using a Markov model reflecting local practices for LTBI treatment.

Setting: A remote Canadian arctic community with a high incidence of TB.

Participants: Hypothetical patients with LTBI.

Interventions: The cost effectiveness of 3HP was compared with the existing standard of care in the study region which consists of 9 months of twice weekly isoniazid (9H) given by directly observed therapy.

Outcome Measures: Effectiveness was measured in quality-adjusted life years (QALYs) with model parameters were derived from historical programmatic data, a local implementation study of 3HP and published literature. Costs from the perspective of the Nunavut healthcare system were measured in 2019 US dollars and were obtained primarily from local, empirically collected data. Secondary health outcomes included estimated TB cases and TB deaths averted using 3HP versus 9H. One way and probabilistic sensitivity analyses were performed.

Results: The 3HP regimen was dominant over 9H: costs were lower (US$628 vs US$924/person) and health outcomes slightly improved (20.14 vs 20.13 QALYs/person). In comparison to 9H, 3HP treatment resulted in fewer TB cases (27.89 vs 30.16/1000 persons) and TB deaths (2.29 vs 2.48/1000 persons). 3HP completion, initiation and risk of fatal adverse events were the primary drivers of cost effectiveness.

Conclusion: In a remote Canadian arctic setting, using 3HP instead of 9H for LTBI treatment may result in cost savings and similar or improved health outcomes.

Citing Articles

Opportunities for tuberculosis elimination in the Canadian Arctic: cost-effectiveness of community-wide screening in a remote Arctic community.

Zwerling A, Veerasingam E, Snyder E, Schertzer A, Travers K, Pim C Lancet Reg Health Am. 2024; 40:100916.

PMID: 39553291 PMC: 11564039. DOI: 10.1016/j.lana.2024.100916.

The Global Expansion of LTBI Screening and Treatment Programs: Exploring Gaps in the Supporting Economic Evidence.

Kota N, Shrestha S, Kashkary A, Samina P, Zwerling A Pathogens. 2023; 12(3.

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Cost-effectiveness of 3-months isoniazid and rifapentine compared to 9-months isoniazid for latent tuberculosis infection: a systematic review.

Lai W, Brethour K, DSilva O, Chaisson R, Zwerling A BMC Public Health. 2022; 22(1):2292.

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Sundell J, Bienvenu E, Birgersson S, Abelo A, Ashton M Antimicrob Agents Chemother. 2022; 66(10):e0227721.

PMID: 36069614 PMC: 9578428. DOI: 10.1128/aac.02277-21.

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