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Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis.

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Date
2012
Authors
Holland, David P
Sanders, Gillian D
Hamilton, Carol D
Stout, Jason E
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Abstract
BACKGROUND: The optimal treatment for latent multiple-drug resistant tuberculosis infection remains unclear. In anticipation of future clinical trials, we modeled the expected performance of six potential regimens for treatment of latent multiple-drug resistant tuberculosis. METHODS: A computerized Markov model to analyze the total cost of treatment for six different regimens: Pyrazinamide/ethambutol, moxifloxacin monotherapy, moxifloxacin/pyrazinamide, moxifloxacin/ethambutol, moxifloxacin/ethionamide, and moxifloxacin/PA-824. Efficacy estimates were extrapolated from mouse models and examined over a wide range of assumptions. RESULTS: In the base-case, moxifloxacin monotherapy was the lowest cost strategy, but moxifloxacin/ethambutol was cost-effective at an incremental cost-effectiveness ratio of $21,252 per quality-adjusted life-year. Both pyrazinamide-containing regimens were dominated due to their toxicity. A hypothetical regimen of low toxicity and even modest efficacy was cost-effective compared to "no treatment." CONCLUSION: In our model, moxifloxacin/ethambutol was the preferred treatment strategy under a wide range of assumptions; pyrazinamide-containing regimens fared poorly because of high rates of toxicity. Although more data are needed on efficacy of treatments for latent MDR-TB infection, data on toxicity and treatment discontinuation, which are easier to obtain, could have a substantial impact on public health practice.
Type
Journal article
Subject
Animals
Antitubercular Agents
Aza Compounds
Cost-Benefit Analysis
Decision Support Techniques
Drug Therapy
Drug Therapy, Combination
Ethambutol
Fluoroquinolones
Humans
Isoniazid
Markov Chains
Mice
Models, Theoretical
Outcome Assessment (Health Care)
Quality-Adjusted Life Years
Quinolines
Rifampin
Tuberculosis, Multidrug-Resistant
Permalink
https://hdl.handle.net/10161/13892
Published Version (Please cite this version)
10.1371/journal.pone.0030194
Publication Info
Holland, David P; Sanders, Gillian D; Hamilton, Carol D; & Stout, Jason E (2012). Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. PLoS One, 7(1). pp. e30194. 10.1371/journal.pone.0030194. Retrieved from https://hdl.handle.net/10161/13892.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Hamilton

Carol Dukes Hamilton

Professor Emeritus of Medicine
Carol Dukes Hamilton, MD, MHS is a Professor of Medicine, Emeritus, in the Infectious Diseases Division, Department of Medicine, Duke University Medical Center.  She has nearly 40 years of experience spanning clinical care, research, public health, and global leadership. She served as clinician and full-time faculty at Duke University Medical Center from 1991 until 2008, concentrating on outpatient and inpatient clinical care (HIV/AIDS, tuberculosis [TB], and routine infectious disease prob
Stout

Jason Eric Stout

Professor of Medicine
My research focuses on the epidemiology, natural history, and treatment of tuberculosis and nontuberculous mycobacterial infections. I am also interested in the impact of HIV infection on mycobacterial infection and disease, and in examining health disparities as they relate to infectious diseases, particularly in immigrant populations.
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