Evaluating the cost-effectiveness of levofloxacin therapy for household contacts of multidrug-resistant tuberculosis in Vietnam
Abstract
Summary Background Multidrug-resistant tuberculosis (TB) threatens global TB control, on account of poor treatment outcomes, high treatment toxicity and costs. Recent trials demonstrated the effectiveness of six-months of levofloxacin (6Lfx) to prevent TB disease among high-risk contacts. However, the cost-effectiveness of this strategy has not previously been evaluated. Methods The VQUIN study was a double-blinded randomised control trial in Vietnam assessing the effectiveness of 6Lfx in household contacts of multidrug resistant/rifampicin resistant TB (MDR/RR-TB) to prevent progression to TB disease. Incorporating in-trial costs and effectiveness outcomes from the VQUIN trial, we developed a closed cohort, decision-analytic Markov model to assess the cost effectiveness of 6Lfx versus placebo in a cohort exposed to MDR/RR-TB in Vietnam. Findings Over a 20-year time horizon, the provision of 6Lfx preventative therapy to household contacts of people infected with MDR/RR-TB was found to gain a total of 40.1 QALYs per 1000 population and save US$23,145 per 1000 population, indicating the strategy was cost saving. MDR/RR-TB cases averted over 20 years was 19.9 per 1000 population treated with 6Lfx, and the number of deaths averted was 3.2 per 1000 people treated. Interpretation 6Lfx therapy is a cost-saving strategy to reduce the incidence of active disease in household contacts of MDR/RR-TB in a resource-limited setting. Funding 10.13039/501100000925National Health and Medical…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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