title: Cost-effectiveness of novel first-line treatment regimens for tuberculosis.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of novel first-line treatment regimens for tuberculosis (TB).
  
  
  METHODS
  Using decision analysis, we projected the costs and effectiveness, from the health care perspective, of treating a patient cohort in the public sector for active TB without known or suspected resistance to first-line drugs. We compared standard (6-month) treatment to hypothetical regimens of equal efficacy, higher cost and shorter duration.
  
  
  RESULTS
  For every 100 TB patients treated, replacing standard treatment with shorter-course regimens would avert an estimated 2-4 failures/relapses, 0.2-0.4 deaths and 8-14 disability-adjusted life years (DALYs), or 6-11% of all DALYs suffered. We identified three primary determinants of cost-effectiveness: drug price, continuation phase treatment delivery costs and deaths averted through fewer relapses. In a high treatment cost scenario (similar to Brazil), averted delivery costs outweighed higher drug costs, making novel regimens cost-saving. In a low treatment cost scenario (similar to the Philippines), a 4-month regimen with a drug price of $1/day cost $66 per patient, or $840 per DALY averted, and became cost-saving if the drug price dropped below $0.37/day.
  
  
  CONCLUSIONS
  Although they avert a small proportion of total DALYs, novel, shorter-course first-line regimens for TB are likely to be cost-effective or cost-saving in most settings.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Owens
authors.forename: M O
authors.initials: MO
authors.lastname: Fofana
authors.forename: D W
authors.initials: DW
authors.lastname: Dowdy
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004185:Disability Evaluation; D004334:Drug Administration Schedule; D016527:Drug Costs; D004359:Drug Therapy, Combination; D006801:Humans; D018803:Models, Economic; D017150:Public Sector / Q000191:economics; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality
chemical_list: D000995:Antitubercular Agents