Feasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients:: a national cohort study in Peru
Feasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients:: a national cohort study in Peru
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DOI：
10.1016/s0140-6736(02)08830-x
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发表时间：
2002-06-08
期刊：
影响因子：
168.9
通讯作者：
Espinal, MA
中科院分区：
文献类型：
--
作者：
Suárez, PG;Floyd, K;Espinal, MA
背景在低收入和中等收入国家，没有关于使用二线药物治疗慢性结核病患者的可行性和成本-效果的数据，其中许多患者感染了结核分枝杆菌的多药耐药(MDR)菌株。方法1997年，秘鲁制定了一个由卡那霉素(仅限3个月)、环丙沙星、乙硫酰胺、吡津酰胺和乙胺丁醇组成的国家计划，采用直接监督的标准化每日方案治疗慢性结核病患者。对1997年10月至1999年3月期间开始治疗的队列的依从性和治疗结果进行了分析。评估了总成本和平均成本。成本-效果被估计为每DALY增加的成本。466名患者被纳入研究，344名患者进行了药物敏感性测试，298名(87%)患有耐多药结核病。225例(48%)治愈，57例(12%)死亡，131例(28%)治疗无效，53例(11%)违约。在413例(89%)患者中，225例(55%)治愈。在MDR患者中，对五种或五种以上药物的耐药性与不良结局显著相关(死亡、治疗无反应或违约；优势比3.37，95%可信区间1.32-8.60；p=0.01)。该方案每年花费60万美元，占国家结核病规划预算的8%，完成治疗的患者每人2381美元。每增加一次DALY的平均成本为211美元(按2002年预测的药价计算为165美元)。在中等收入国家，如果有强有力的结核病控制方案，用二线药物解释治疗耐多药水平高的慢性结核病患者是可行的和具有成本效益的。
Background There are no data on the feasibility and cost-effectiveness of using second-line drugs to treat patients with chronic tuberculosis, many of whom are infected with multidrug resistant (MDR) strains of Mycobacterium tuberculosis, in low or middle-income countries.Methods A national programme to treat chronic tuberculosis patients with a directly observed standardised 18-month daily regimen, consisting of kanamycin (3 months only), ciprofloxacin, ethionamide, pyrazinamide, and ethambutol, was established in Peru in 1997. Compliance and treatment outcomes were analysed for the cohort started on treatment between October, 1997, and March, 1999. Total and average costs were assessed. Cost-effectiveness was estimated as the cost per DALY gained.Findings 466 patients were enrolled; 344 were tested for drug susceptibility and 298 (87%) had MDR tuberculosis. 225 patients (48%) were cured, 57 (12%) died, 131 (28%) did not respond to treatment, and 53 (11%) defaulted. Of the 413 (89%) patients who complied with treatment, 225 (55%) were cured. Among MDR patients, resistance to five or more drugs was significantly associated with an unfavourable outcome (death, non-response to treatment, or default; odds ratio 3.37, 95% CI 1.32-8.60; p=0.01). The programme cost US$0.6 million per year, 8% of the National Tuberculosis Programme budget, and US$2381 per patient for those who completed treatment. The mean cost per DALY gained was $211 ($165 at drug prices projected for 2002).Interpretation Treating chronic tuberculosis patients with high levels of MDR with second-line drugs can be feasible and cost-effective in middle-income countries, provided a strong tuberculosis control programme is in place.