Cost Resulting from Anti-Tuberculosis Drug Shortages in the United States: A Hypothetical Cohort Study.
Cost Resulting from Anti-Tuberculosis Drug Shortages in the United States: A Hypothetical Cohort Study.
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DOI：
10.1371/journal.pone.0134597
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Flood J
中科院分区：
文献类型：
--
作者：
Scott JC;Shah N;Porco T;Flood J
从2012年到2014年，美国经历了几种一线抗结核药物的严重短缺和价格上涨。由于二级结核病药物治疗方案更长，不良事件发生更频繁，我们试图保守估计药物短缺期间替代方案的结核病治疗和药物不良事件对患者和卫生保健系统的成本。我们评估了在不使用异烟肼（INH）、利福平（RIF）或吡嗪酰胺（PZA）或同时使用INH和RIF的情况下治疗结核病的费用。我们模拟不良事件的基础上公布的概率使用每月离散时间随机模型。对于总成本，我们使用程序术语代码汇总了药物、常规检查和不良事件治疗的成本。我们报告了药物短缺期间结核病治疗与标准结核病治疗的平均成本比。不含INH、RIF或PZA的TB治疗与标准治疗的成本比分别高1.7（范围：1.2，2.3）、4.9（范围：3.2，7.3）和1.1（范围：0.7，1.7）倍。在不同时使用INH和RIF的情况下，成本比高出18.6倍（范围：10.0，39.0）。当INH、RIF和PZA的价格增加时，标准治疗的成本增加了2.7倍（范围：1.9，3.0）。在接受标准治疗时发生至少1起不良事件的患者百分比为3.9%（范围：1.3%，11.8%）。当RIF不可用时，该百分比增加至51.5%（范围：20.1%，83.8%），当INH和RIF均不可用时，该百分比增加至82.5%（范围：41.2%，98.5%）。我们的保守模型表明，一线抗结核药物的中断会导致患者明显的额外费用和不良事件。应确保这些药物在美国的供应。将替代疗法的有效性、治疗开始的延迟和结核病传播结合起来的模型可以为药物短缺的影响提供更广泛的视角。
From 2012 through 2014, the United States experienced acute shortages and price escalations of several first-line anti-tuberculosis (TB) medications. Because secondary TB drug regimens are longer and adverse events occur more frequently with them, we sought to conservatively estimate the cost, to patients and the health care system, of TB treatment and medication adverse events from alternative regimens during drug shortages. We assessed the cost of treatment for TB disease in the absence of isoniazid (INH), rifampin (RIF), or pyrazinamide (PZA), or both INH and RIF. We simulated adverse events based on published probabilities using a monthly discrete-time stochastic model. For total costs, we summed costs of medications, routine testing, and treatment of adverse events using procedural terminology codes. We report average cost ratios of TB treatment during drug shortages to standard TB treatment. The cost ratio of TB treatment without INH, RIF, or PZA to standard treatment was 1.7 (Range: 1.2, 2.3), 4.9 (Range: 3.2, 7.3), and 1.1 (Range: 0.7, 1.7) times higher, respectively. Without both INH and RIF, the cost ratio was 18.6 (Range: 10.0, 39.0) times higher. When the prices for INH, RIF and PZA were increased, the cost for standard treatment increased by a factor of 2.7 (Range: 1.9, 3.0). The percentage of patients experiencing at least one adverse event while taking standard therapy was 3.9% (Range: 1.3%, 11.8%). This percentage increased to 51.5% (Range: 20.1%, 83.8%) when RIF was unavailable, and increased to 82.5% (Range: 41.2%, 98.5%) when both INH and RIF were unavailable. Our conservative model illustrates that an interruption in first-line anti-TB medications leads to appreciable additional costs and adverse events for patients. The availability of these drugs in the United States should be ensured. Models that incorporate the effectiveness of alternative regimens, delays in treatment initiation, and TB transmission can provide broader perspectives on the impact of drug shortages.