Cost and cost-effectiveness of tuberculosis treatment shortening: A model-based analysis

G. B. Gomez, D. W. Dowdy, M. L. Bastos, A. Zwerling, S. Sweeney, N. Foster, A. Trajman, M. A. Islam, S. Kapiga, E. Sinanovic, G. M. Knight, R. G. White, W. A. Wells, F. G. Cobelens, A. Vassall

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: Despite improvements in treatment success rates for tuberculosis (TB), current six-month regimen duration remains a challenge for many National TB Programmes, health systems, and patients. There is increasing investment in the development of shortened regimens with a number of candidates in phase 3 trials. Methods: We developed an individual-based decision analytic model to assess the cost-effectiveness of a hypothetical four-month regimen for first-line treatment of TB, assuming non-inferiority to current regimens of six-month duration. The model was populated using extensive, empirically-collected data to estimate the economic impact on both health systems and patients of regimen shortening for first-line TB treatment in South Africa, Brazil, Bangladesh, and Tanzania. We explicitly considered 'real world' constraints such as sub-optimal guideline adherence. Results: From a societal perspective, a shortened regimen, priced at USD1 per day, could be a cost-saving option in South Africa, Brazil, and Tanzania, but would not be cost-effective in Bangladesh when compared to one gross domestic product (GDP) per capita. Incorporating 'real world' constraints reduces cost-effectiveness. Patient-incurred costs could be reduced in all settings. From a health service perspective, increased drug costs need to be balanced against decreased delivery costs. The new regimen would remain a cost-effective option, when compared to each countries' GDP per capita, even if new drugs cost up to USD7.5 and USD53.8 per day in South Africa and Brazil; this threshold was above USD1 in Tanzania and under USD1 in Bangladesh. Conclusion: Reducing the duration of first-line TB treatment has the potential for substantial economic gains from a patient perspective. The potential economic gains for health services may also be important, but will be context-specific and dependent on the appropriate pricing of any new regimen.

Original languageEnglish (US)
Article number726
JournalBMC infectious diseases
Issue number1
StatePublished - Dec 1 2016


  • Cost-effectiveness
  • Economic evaluation
  • New technologies
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases


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