Abstract：
We conducted a systematic review examining the cost effectiveness of a 3-month course of isoniazid and rifapentine, known as 3HP, given by directly observed treatment, compared to 9 months of isoniazid that is directly observed or self-administered, for latent tuberculosis infection. 3HP has shown to be effective in reducing progression to active tuberculosis and like other short-course regimens, has higher treatment completion rates compared to standard regimens such as 9 months of isoniazid. Decision makers would benefit from knowing if the higher up-front costs of rifapentine and of the human resources needed for directly observed treatment are worth the investment for improved outcomes.
We searched PubMed, Embase, CINAHL, LILACS, and Web of Science up to February 2022 with search concepts combining latent tuberculosis infection, directly observed treatment, and cost or cost-effectiveness. Studies included were in English or French, on human subjects, with latent tuberculosis infection, provided information on specified anti-tubercular therapy regimens, had a directly observed treatment arm, and described outcomes with some cost or economic data. We excluded posters and abstracts, treatment for multiple drug resistant tuberculosis, and combined testing and treatment strategies. We then restricted our findings to studies examining directly-observed 3HP for comparison. The primary outcome was the cost and cost-effectiveness of directly-observed 3HP.
We identified 3 costing studies and 7 cost-effectiveness studies. The 3 costing studies compared directly-observed 3HP to directly-observed 9 months of isoniazid. Of the 7 cost-effectiveness studies, 4 were modelling studies based in high-income countries; one study was modelled on a high tuberculosis incidence population in the Canadian Arctic, using empiric costing data from that setting; and 2 studies were conducted in a low-income, high HIV-coinfection rate population. In five studies, directly-observed 3HP compared to self-administered isoniazid for 9 months in high-income countries, has incremental cost-effectiveness ratios that range from cost-saving to $5418 USD/QALY gained. While limited, existing evidence suggests 3HP may not be cost-effective in low-income, high HIV-coinfection settings.
Cost-effectiveness should continue to be assessed for programmatic planning and scale-up, and may vary depending on existing systems and local context, including prevalence rates and patient expectations and preferences.
We searched PubMed, Embase, CINAHL, LILACS, and Web of Science up to February 2022 with search concepts combining latent tuberculosis infection, directly observed treatment, and cost or cost-effectiveness. Studies included were in English or French, on human subjects, with latent tuberculosis infection, provided information on specified anti-tubercular therapy regimens, had a directly observed treatment arm, and described outcomes with some cost or economic data. We excluded posters and abstracts, treatment for multiple drug resistant tuberculosis, and combined testing and treatment strategies. We then restricted our findings to studies examining directly-observed 3HP for comparison. The primary outcome was the cost and cost-effectiveness of directly-observed 3HP.
We identified 3 costing studies and 7 cost-effectiveness studies. The 3 costing studies compared directly-observed 3HP to directly-observed 9 months of isoniazid. Of the 7 cost-effectiveness studies, 4 were modelling studies based in high-income countries; one study was modelled on a high tuberculosis incidence population in the Canadian Arctic, using empiric costing data from that setting; and 2 studies were conducted in a low-income, high HIV-coinfection rate population. In five studies, directly-observed 3HP compared to self-administered isoniazid for 9 months in high-income countries, has incremental cost-effectiveness ratios that range from cost-saving to $5418 USD/QALY gained. While limited, existing evidence suggests 3HP may not be cost-effective in low-income, high HIV-coinfection settings.
Cost-effectiveness should continue to be assessed for programmatic planning and scale-up, and may vary depending on existing systems and local context, including prevalence rates and patient expectations and preferences.
摘要：
背景：我们进行了一项系统评价，检查了异烟肼和利福喷丁3个月疗程的成本效益，被称为3HP，通过直接观察治疗给出，与直接观察或自行给药的9个月异烟肼相比，潜伏性结核感染。3HP已显示可有效减少进展为活动性结核病和其他短程治疗方案，与标准方案如9个月的异烟肼相比，治疗完成率更高。决策者将受益于了解利福喷丁的较高前期成本和直接观察治疗所需的人力资源是否值得投资以改善结果。
方法：我们搜索了PubMed，Embase,CINAHL,LILACS,和WebofScience，直到2022年2月，搜索概念结合了潜伏的结核病感染，直接观察治疗，和成本或成本效益。研究包括英语或法语，关于人类主题，潜伏性结核感染，提供了有关特定抗结核治疗方案的信息，有一个直接观察的治疗臂，并用一些成本或经济数据描述了结果。我们排除了海报和摘要，耐多药结核病的治疗，并结合测试和治疗策略。然后，我们将我们的发现限制在研究直接观察到的3HP进行比较。主要结果是直接观察3HP的成本和成本效益。
结果：我们确定了3项成本研究和7项成本效益研究。3项成本研究将直接观察到的3HP与直接观察到的9个月异烟肼进行了比较。在7项成本效益研究中，4是基于高收入国家的建模研究；一项研究以加拿大北极地区的高结核病发病率为模型，使用来自该环境的经验成本计算数据；两项研究是在低收入人群中进行的，高HIV合并感染率人群。在五项研究中，在高收入国家，直接观察3HP与自给异烟肼9个月相比，具有从节省成本到获得5418美元/季度的增量成本效益比。虽然有限，现有证据表明，3HP在低收入人群中可能不划算，高HIV合并感染设置。
结论：应继续评估方案规划和扩大规模的成本效益，并且可能因现有系统和本地环境而异，包括患病率和患者的期望和偏好。
方法：我们搜索了PubMed，Embase,CINAHL,LILACS,和WebofScience，直到2022年2月，搜索概念结合了潜伏的结核病感染，直接观察治疗，和成本或成本效益。研究包括英语或法语，关于人类主题，潜伏性结核感染，提供了有关特定抗结核治疗方案的信息，有一个直接观察的治疗臂，并用一些成本或经济数据描述了结果。我们排除了海报和摘要，耐多药结核病的治疗，并结合测试和治疗策略。然后，我们将我们的发现限制在研究直接观察到的3HP进行比较。主要结果是直接观察3HP的成本和成本效益。
结果：我们确定了3项成本研究和7项成本效益研究。3项成本研究将直接观察到的3HP与直接观察到的9个月异烟肼进行了比较。在7项成本效益研究中，4是基于高收入国家的建模研究；一项研究以加拿大北极地区的高结核病发病率为模型，使用来自该环境的经验成本计算数据；两项研究是在低收入人群中进行的，高HIV合并感染率人群。在五项研究中，在高收入国家，直接观察3HP与自给异烟肼9个月相比，具有从节省成本到获得5418美元/季度的增量成本效益比。虽然有限，现有证据表明，3HP在低收入人群中可能不划算，高HIV合并感染设置。
结论：应继续评估方案规划和扩大规模的成本效益，并且可能因现有系统和本地环境而异，包括患病率和患者的期望和偏好。
