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

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2011

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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.

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10.1371/journal.pone.0022276

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Holland, David P, Gillian D Sanders, Carol D Hamilton and Jason E Stout (2011). Potential economic viability of two proposed rifapentine-based regimens for treatment of latent tuberculosis infection. PLoS One, 6(7). p. e22276. 10.1371/journal.pone.0022276 Retrieved from https://hdl.handle.net/10161/13901.

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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 problems). She expanded the nascent Antibiotic Decision Support Team (ADST) and helped establish the Division’s research program in Dar es Salaam, and later Moshi, Tanzania. While at Duke, Dr. Hamilton led the North Carolina TB Control Program in Raleigh, from 2001-2008, serving as the TB Controller for the State.  After achieving Full Professor, with Tenure status at Duke, she was recruited to Family Health International (now FHI 360) to lead development of their TB research portfolio of work, and subsequently led all TB programmatic work as well, working in numerous countries in sub-Saharan Africa (primarily Zambia, Mozambique and Nigeria), and Asia (primarily China, Myanmar, Indonesia, Cambodia), while maintaining her Duke affiliation as a Consulting Professor.  She served in several leadership positions at FHI 360, including Director of Scientific Affairs in the largest unit, the Global Health, Population & Nutrition Group, where she oversaw the quality of research done globally in health and nutrition at the organization. Dr. Hamilton has over 100 peer-reviewed publications, mostly focused on HIV/AIDS, TB and the intersection between the two diseases.  Dr. Hamilton has won numerous awards including the CDC’s Charles C. Shepard Science Award (2012), the National TB Controllers Association’s Robert Koch Award (2012), the International TB Control Cooperation Award from the China Clinical Center on Tuberculosis and the National TB Society (2014), and the US CDC’s Fred Gordin TBTC award (2018).  She retired from FHI 360 in 2018, and is now Professor, Emeritus at Duke, providing mentoring and consultation at both Duke and FHI 360.


Key words: Tuberculosis; mycobacteria other than TB (MOTT); HIV/AIDS; HAART; genomics; global health; public health;

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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