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Strategies for Treating Latent Multiple-Drug Resistant Tuberculosis: A Decision Analysis

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  • David P Holland
  • Gillian D Sanders
  • Carol D Hamilton
  • Jason E Stout

Abstract

Background: 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. Methods: 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. Results: 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.” Conclusion: 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.

Suggested Citation

  • David P Holland & Gillian D Sanders & Carol D Hamilton & Jason E Stout, 2012. "Strategies for Treating Latent Multiple-Drug Resistant Tuberculosis: A Decision Analysis," PLOS ONE, Public Library of Science, vol. 7(1), pages 1-9, January.
    • Handle: RePEc:plo:pone00:0030194
    DOI: 10.1371/journal.pone.0030194
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    References listed on IDEAS

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    1. Frank A. Sonnenberg & J. Robert Beck, 1993. "Markov Models in Medical Decision Making," Medical Decision Making, , vol. 13(4), pages 322-338, December.
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