Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis.
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 articleSubject
AnimalsAntitubercular 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
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https://hdl.handle.net/10161/13892Published Version (Please cite this version)
10.1371/journal.pone.0030194Publication 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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Show full item recordScholars@Duke
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
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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