Article Text

Original research
Cost-effectiveness analysis of 3 months of weekly rifapentine and isoniazid compared to isoniazid monotherapy in a Canadian arctic setting
  1. Christopher Pease1,2,
  2. Gonzalo Alvarez1,2,
  3. Ranjeeta Mallick2,
  4. Mike Patterson3,
  5. Sandy Finn3,
  6. Yahya Habis4,
  7. Kevin Schwartzman5,6,
  8. Elaine Kilabuk7,
  9. Sunita Mulpuru1,2,
  10. Alice Zwerling8
  1. 1Division of Respirology, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
  2. 2Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  3. 3Department of Health, Government of Nunavut, Iqaluit, Nunavut, Canada
  4. 4Deparment of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  5. 5Montreal Chest Institute, Montreal, Quebec, Canada
  6. 6Department of Medicine, McGill University, Montreal, Quebec, Canada
  7. 7Department of Internal Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  8. 8School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Christopher Pease; Cpease{at}toh.ca

Abstract

Objective To assess the cost effectiveness of once weekly rifapentine and isoniazid for 12 weeks (3HP) to the current standard care for latent tuberculosis (TB) infection (LTBI) in Iqaluit, Nunavut.

Design A cost-effectiveness analysis using a Markov model reflecting local practices for LTBI treatment.

Setting A remote Canadian arctic community with a high incidence of TB.

Participants Hypothetical patients with LTBI.

Interventions The cost effectiveness of 3HP was compared with the existing standard of care in the study region which consists of 9 months of twice weekly isoniazid (9H) given by directly observed therapy.

Outcome measures Effectiveness was measured in quality-adjusted life years (QALYs) with model parameters were derived from historical programmatic data, a local implementation study of 3HP and published literature. Costs from the perspective of the Nunavut healthcare system were measured in 2019 US dollars and were obtained primarily from local, empirically collected data. Secondary health outcomes included estimated TB cases and TB deaths averted using 3HP versus 9H. One way and probabilistic sensitivity analyses were performed.

Results The 3HP regimen was dominant over 9H: costs were lower (US$628 vs US$924/person) and health outcomes slightly improved (20.14 vs 20.13 QALYs/person). In comparison to 9H, 3HP treatment resulted in fewer TB cases (27.89 vs 30.16/1000 persons) and TB deaths (2.29 vs 2.48/1000 persons). 3HP completion, initiation and risk of fatal adverse events were the primary drivers of cost effectiveness.

Conclusion In a remote Canadian arctic setting, using 3HP instead of 9H for LTBI treatment may result in cost savings and similar or improved health outcomes.

  • tuberculosis
  • preventive medicine
  • health economics

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors GA, MP, SF and AZ conceived the study. The study was designed by AZ, CP and GA. SF and EK collected data. Data analysis was performed by CP with assistance from AZ. CP, AZ and GA interpreted the data with assistance from KS, RM, SM, MP, SF, EK and YH. CP drafted the initial manuscript, which was revised and approved by all authors. CP takes responsibility for the integrity of the data and accuracy of the data analysis.

  • Funding The study was funded by the Public Health Agency of Canada.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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