Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis.
The optimal treatment for latent multiple-drug resistant tuberculosis infection remains unclear. In anticipation of future clinical trials, we modeled the expected performance of six potential regimens for treatment of latent multiple-drug resistant tuberculosis.A computerized Markov model to analyz...
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2012-01-01
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doaj-87f5b154989847f7a9fbe7ac548aa1aa2020-11-25T00:23:25ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0171e3019410.1371/journal.pone.0030194Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis.David P HollandGillian D SandersCarol D HamiltonJason E StoutThe optimal treatment for latent multiple-drug resistant tuberculosis infection remains unclear. In anticipation of future clinical trials, we modeled the expected performance of six potential regimens for treatment of latent multiple-drug resistant tuberculosis.A computerized Markov model to analyze the total cost of treatment for six different regimens: Pyrazinamide/ethambutol, moxifloxacin monotherapy, moxifloxacin/pyrazinamide, moxifloxacin/ethambutol, moxifloxacin/ethionamide, and moxifloxacin/PA-824. Efficacy estimates were extrapolated from mouse models and examined over a wide range of assumptions.In the base-case, moxifloxacin monotherapy was the lowest cost strategy, but moxifloxacin/ethambutol was cost-effective at an incremental cost-effectiveness ratio of $21,252 per quality-adjusted life-year. Both pyrazinamide-containing regimens were dominated due to their toxicity. A hypothetical regimen of low toxicity and even modest efficacy was cost-effective compared to "no treatment."In our model, moxifloxacin/ethambutol was the preferred treatment strategy under a wide range of assumptions; pyrazinamide-containing regimens fared poorly because of high rates of toxicity. Although more data are needed on efficacy of treatments for latent MDR-TB infection, data on toxicity and treatment discontinuation, which are easier to obtain, could have a substantial impact on public health practice.http://europepmc.org/articles/PMC3260212?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
David P Holland Gillian D Sanders Carol D Hamilton Jason E Stout |
spellingShingle |
David P Holland Gillian D Sanders Carol D Hamilton Jason E Stout Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. PLoS ONE |
author_facet |
David P Holland Gillian D Sanders Carol D Hamilton Jason E Stout |
author_sort |
David P Holland |
title |
Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
title_short |
Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
title_full |
Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
title_fullStr |
Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
title_full_unstemmed |
Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
title_sort |
strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2012-01-01 |
description |
The optimal treatment for latent multiple-drug resistant tuberculosis infection remains unclear. In anticipation of future clinical trials, we modeled the expected performance of six potential regimens for treatment of latent multiple-drug resistant tuberculosis.A computerized Markov model to analyze the total cost of treatment for six different regimens: Pyrazinamide/ethambutol, moxifloxacin monotherapy, moxifloxacin/pyrazinamide, moxifloxacin/ethambutol, moxifloxacin/ethionamide, and moxifloxacin/PA-824. Efficacy estimates were extrapolated from mouse models and examined over a wide range of assumptions.In the base-case, moxifloxacin monotherapy was the lowest cost strategy, but moxifloxacin/ethambutol was cost-effective at an incremental cost-effectiveness ratio of $21,252 per quality-adjusted life-year. Both pyrazinamide-containing regimens were dominated due to their toxicity. A hypothetical regimen of low toxicity and even modest efficacy was cost-effective compared to "no treatment."In our model, moxifloxacin/ethambutol was the preferred treatment strategy under a wide range of assumptions; pyrazinamide-containing regimens fared poorly because of high rates of toxicity. Although more data are needed on efficacy of treatments for latent MDR-TB infection, data on toxicity and treatment discontinuation, which are easier to obtain, could have a substantial impact on public health practice. |
url |
http://europepmc.org/articles/PMC3260212?pdf=render |
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