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

Holland, David P

Sanders, Gillian D

Hamilton, Carol D

Stout, Jason E

Cardona, Pere-Joan

United States

2017-04-01T13:17:53Z

2017-04-01T13:17:53Z

2012

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.

https://www.ncbi.nlm.nih.gov/pubmed/22272302

PONE-D-11-20203

1932-6203

https://hdl.handle.net/10161/13892

eng

Public Library of Science (PLoS)

PLoS One

10.1371/journal.pone.0030194

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

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

Journal article

Stout, Jason E|0000-0002-6698-8176

https://www.ncbi.nlm.nih.gov/pubmed/22272302

e30194

1

Basic Science Departments

Biostatistics & Bioinformatics

Clinical Science Departments

Duke

Duke Clinical Research Institute

Faculty

Institutes and Centers

Medicine

Medicine, Clinical Pharmacology

Medicine, Infectious Diseases

School of Medicine

Published

7