Cost-effectiveness of treating multidrug-resistant tuberculosis

Researchers have made predictions as to how the tuberculosis (TB) epidemic in Peru might progress over the next 30 years, depending on what measures are used to fight it. They considered the five different approaches to treating drug-resistant TB that are open to the Peruvian health authorities.

TB is a growing problem worldwide. Most cases can be treated effectively with a standard treatment (known as 'DOTS', which stands for 'Directly Observed Therapy Short-Course') but an increasing number of cases are resistant to all the various 'first-line' treatment drugs; this is known as multi-drug resistant (MDR) TB. MDR-TB must be treated with 'second-line' drugs. There are several different options; for example, doctors could give second-line drugs whenever a first attempt at treatment has failed, or only use these drugs in cases where tests have confirmed MDR-TB to be the problem. MDR-TB cases could all be given the same standard treatment or, based on tests, each could have 'individualized' treatment.

The researchers used a method called 'modelling'. They performed calculations based on information already available about TB in Peru, where there are 120 new TB infections per 100,000 people every year and 4.5% of existing cases have MDR-TB. They concluded that use of second-line drugs would be cost-effective for Peru and that, despite the extra costs of individualized treatment, this is the best option. The results will be of interest in other developing countries. The researchers say, "In other settings, the attractiveness of strategies using second-line drugs will depend on TB incidence, MDR burden, and the available budget, but simulation results suggest that individualized regimens would be cost-effective in a wide range of situations". They also stress it is important for the standard first-line DOTS treatment to be made widely available.

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Citation: Resch SC, Salomon JA, Murray M, Weinstein MC (2006) Cost-effectiveness of treating multidrug-resistant tuberculosis. PLoS Med 3(7): e241.

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