title: Potential economic viability of two proposed rifapentine-based regimens for treatment of latent tuberculosis infection.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America. david.p.holland@duke.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Holland
authors.forename: Gillian D
authors.initials: GD
authors.lastname: Sanders
authors.forename: Carol D
authors.initials: CD
authors.lastname: Hamilton
authors.forename: Jason E
authors.initials: JE
authors.lastname: Stout
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D055985:Latent Tuberculosis / Q000188:drug therapy* / Q000191:economics*; D008954:Models, Biological; D010349:Patient Compliance; D012293:Rifampin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D012646:Self Administration; D014481:United States
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin; C018421:rifapentine