Rifampicin for Continuation Phase Tuberculosis Treatment in Uganda A Cost-Effectiveness Analysis 英文参考文献.docVIP

RifampicinforContinuationPhaseTuberculosis TreatmentinUganda:ACost-EffectivenessAnalysis YukariC.Manabe1,2*,SabineM.Hermans1,3,MohammedLamorde1,4,BarbaraCastelnuovo1 ,C. DanielMullins5,AndreasKuznik6 1InfectiousDiseasesInstitute,MakerereUniversityCollegeofHealthSciences,Kampala,Uganda,2DivisionofInfectiousDiseases,DepartmentofMedicine,JohnsHopkins School of Medicine, Baltimore, Maryland, United States of America, 3Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, 4Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland, 5UniversityofMaryland,Baltimore,Maryland,UnitedStatesofAmerica,6PfizerInc.,NewYork,NewYork,UnitedStatesofAmerica Abstract Background:InUganda,isoniazidplusethambutolisusedfor6months(6HE)duringthecontinuationtreatmentphaseof newtuberculosis(TB)cases.However,theWorldHealthOrganization(WHO)recommendsusingisoniazidplusrifampicinfor 4 months (4HR) instead of 6HE. We compared the impact of a continuation phase using 6HE or 4HR on total cost and expectedmortalityfromtheperspectiveoftheUgandannationalhealthsystem. Methodology/PrincipalFindings:Treatmentcostsandoutcomesweredeterminedbydecisionanalysis.Mediandailydrug pricewasUS$0.115forHRandUS$0.069forHE.TBtreatmentfailureorrelapseandmortalityratesassociatedwith6HEvs. 4HRwereobtainedfromrandomizedtrialsandsystematicreviewsforHIV-negative(46%ofTBcases;failure/relapse–6HE: 10.4%vs.4HR:5.2%;mortality–6HE:5.6%vs.4HR:3.5%)andHIV-positivepatients(54%ofTBcases;failureorrelapse–6HE: 13.7% vs. 4HR: 12.4%; mortality –6HE: 16.6% vs. 4HR: 10.5%). When the initial treatment is not successful, retreatment involves an additional 8-month drug-regimen at a cost of $110.70. The model predicted a mortality rate of 13.3% for patientstreatedwith6HEand8.8%for4HR;averagetreatmentcostperpatientwaspredictedat$26.07for6HEand$23.64 for4HR.TheseresultswererobusttotheinclusionofMDR-TBasanadditiona