rifampicin for continuation phase tuberculosis treatment in uganda a cost-effectiveness analysis利福平为延续阶段结核病治疗在乌干达一个成本效益分析.pdfVIP

Rifampicin for Continuation Phase Tuberculosis Treatment in Uganda: A Cost-Effectiveness Analysis 1,2 1,3 1,4 1 Yukari C. Manabe *, Sabine M. Hermans , Mohammed Lamorde , Barbara Castelnuovo , C. Daniel Mullins5, Andreas Kuznik6 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda, 2 Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America, 3 Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, 4 Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland, 5 University of Maryland, Baltimore, Maryland, United States of America, 6 Pfizer Inc., New York, New York, United States of America Abstract Background: In Uganda, isoniazid plus ethambutol is used for 6 months (6HE) during the continuation treatment phase of new tuberculosis (TB) cases. However, the World Health Organization (WHO) recommends using isoniazid plus rifampicin for 4 months (4HR) instead of 6HE. We compared the impact of a continuation phase using 6HE or 4HR on total cost and expected mortality from the perspective of the Ugandan national health system. Methodology/Principal Findings: Treatment costs and outcomes were determined by decision analysis. Median daily drug price was US$0.115 for HR and US$0.069 for HE. TB treatment failure or relapse and mortality rates associated with 6HE vs. 4HR were obtained from randomized trials and systematic reviews for HIV-negative (46% of TB cases; failure/relapse –6HE: 10.4% vs. 4HR: 5.2%; mortality –6HE: 5.6% vs. 4