Potential economic viability of two proposed rifapentine-based regimens for treatment of latent tuberculosis infection

PLoS One. 2011;6(7):e22276. doi: 10.1371/journal.pone.0022276. Epub 2011 Jul 18.

Abstract

Rationale: Rifapentine-based regimens for treating latent tuberculosis infection (LTBI) are being considered for future clinical trials, but even if they prove effective, high drug costs may limit their economic viability.

Objectives: To inform clinical trial design by estimating the potential costs and effectiveness of rifapentine-based regimens for treatment of latent tuberculosis infection (LTBI).

Methods: We used a Markov model to estimate cost and societal benefits for three regimens for treating LTBI: Isoniazid/rifapentine daily for one month, isoniazid/rifapentine weekly for three months (self-administered and directly-observed), and isoniazid daily for nine months; a strategy of "no treatment" used for comparison. Costs, quality-adjusted life-years gained, and instances of active tuberculosis averted were calculated for all arms.

Results: Both daily isoniazid/rifapentine for one month and weekly isoniazid/rifapentine for three months were less expensive and more effective than other strategies under a wide variety of clinically plausibly parameter estimates. Daily isoniazid/rifapentine for one month was the least expensive and most effective regimen.

Conclusions: Daily isoniazid/rifapentine for one month and weekly isoniazid/rifapentine for three months should be studied in a large-scale clinical trial for efficacy. Because both regimens performed well even if their efficacy is somewhat reduced, study designers should consider relaxing non-inferiority boundaries.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Antitubercular Agents / administration & dosage
  • Antitubercular Agents / economics*
  • Antitubercular Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Drug Administration Schedule
  • Humans
  • Isoniazid / administration & dosage
  • Isoniazid / economics
  • Isoniazid / therapeutic use
  • Latent Tuberculosis / drug therapy*
  • Latent Tuberculosis / economics*
  • Models, Biological
  • Patient Compliance
  • Rifampin / administration & dosage
  • Rifampin / analogs & derivatives*
  • Rifampin / economics
  • Rifampin / therapeutic use
  • Self Administration
  • United States

Substances

  • Antitubercular Agents
  • Isoniazid
  • Rifampin
  • rifapentine