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dc.contributor.authorResch, Stephen C
dc.contributor.authorSalomon, Joshua A.
dc.contributor.authorMurray, Megan Blanche
dc.contributor.authorWeinstein, Milton C.
dc.date.accessioned2012-02-13T20:38:12Z
dc.date.issued2006
dc.identifier.citationResch, Stephen C., Joshua A. Salomon, Megan Murray, and Milton C. Weinstein. 2006. Cost-effectiveness of treating multidrug-resistant tuberculosis. PLoS Medicine 3(7): e241.en_US
dc.identifier.issn1549-1277en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:8160714
dc.description.abstractBackground: Despite the existence of effective drug treatments, tuberculosis (TB) causes 2 million deaths annually worldwide. Effective treatment is complicated by multidrug-resistant TB (MDR TB) strains that respond only to second-line drugs. We projected the health benefits and cost-effectiveness of using drug susceptibility testing and second-line drugs in a lower-middle-income setting with high levels of MDR TB. Methods and Findings: We developed a dynamic state-transition model of TB. In a base case analysis, the model was calibrated to approximate the TB epidemic in Peru, a setting with a smear-positive TB incidence of 120 per 100,000 and 4.5% MDR TB among prevalent cases. Secondary analyses considered other settings. The following strategies were evaluated: first-line drugs administered under directly observed therapy (DOTS), locally standardized second-line drugs for previously treated cases (STR1), locally standardized second-line drugs for previously treated cases with test-confirmed MDR TB (STR2), comprehensive drug susceptibility testing and individualized treatment for previously treated cases (ITR1), and comprehensive drug susceptibility testing and individualized treatment for all cases (ITR2). Outcomes were costs per TB death averted and costs per quality-adjusted life year (QALY) gained. We found that strategies incorporating the use of second-line drug regimens following first-line treatment failure were highly cost-effective compared to strategies using first-line drugs only. In our base case, standardized second-line treatment for confirmed MDR TB cases (STR2) had an incremental cost-effectiveness ratio of $720 per QALY ($8,700 per averted death) compared to DOTS. Individualized second-line drug treatment for MDR TB following first-line failure (ITR1) provided more benefit at an incremental cost of $990 per QALY ($12,000 per averted death) compared to STR2. A more aggressive version of the individualized treatment strategy (ITR2), in which both new and previously treated cases are tested for MDR TB, had an incremental cost-effectiveness ratio of $11,000 per QALY ($160,000 per averted death) compared to ITR1. The STR2 and ITR1 strategies remained cost-effective under a wide range of alternative assumptions about treatment costs, effectiveness, MDR TB prevalence, and transmission. Conclusions: Treatment of MDR TB using second-line drugs is highly cost-effective in Peru. In other settings, the attractiveness of strategies using second-line drugs will depend on TB incidence, MDR burden, and the available budget, but simulation results suggest that individualized regimens would be cost-effective in a wide range of situations.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pmed.0030241en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483913/pdf/en_US
dash.licenseLAA
dc.subjectinfectious diseasesen_US
dc.subjectmicrobiologyen_US
dc.subjectclinical pharmacologyen_US
dc.subjecthealth economicsen_US
dc.subjectpublic healthen_US
dc.subjecthealth policyen_US
dc.subjecttuberculosisen_US
dc.titleCost-Effectiveness of Treating Multidrug-Resistant Tuberculosisen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS Medicineen_US
dash.depositing.authorResch, Stephen C
dc.date.available2012-02-13T20:38:12Z
dash.affiliation.otherSPH^Health Policy and Managementen_US
dash.affiliation.otherSPH^Global Health + Populationen_US
dash.affiliation.otherSPH^Epidemiologyen_US
dash.affiliation.otherHMS^Medicine-Brigham and Women's Hospitalen_US
dash.affiliation.otherSPH^Center for Risk Analysisen_US
dash.affiliation.otherSPH^Health Policy and Managementen_US
dash.affiliation.otherHMS^Medicine-Brigham and Women's Hospitalen_US
dc.identifier.doi10.1371/journal.pmed.0030241*
dash.contributor.affiliatedResch, Stephen
dash.contributor.affiliatedMurray, Megan
dash.contributor.affiliatedWeinstein, Milton
dash.contributor.affiliatedSalomon, Joshua
dc.identifier.orcid0000-0003-3929-5515


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