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Sodré-Alves BMC, Toledo MM, Zimmermann IR, Araújo WND, Tavares NUL. Isoniazid use, effectiveness, and safety for treatment of latent tuberculosis infection: a systematic review. Rev Soc Bras Med Trop 2024; 57:e004022024. [PMID: 38536998 PMCID: PMC10962359 DOI: 10.1590/0037-8682-0504-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/09/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND The treatment strategy for latent tuberculosis infection is to reduce the number of tuberculosis cases and consequently reduce the transmission of pathogenic bacteria. This study aimed to determine the safety, effectiveness, and adherence of isoniazid use for latent tuberculosis infection treatment. METHODS To identify studies on isoniazid use for latent tuberculosis infection, five electronic databases were searched. The methods and results are presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Most studies (53) used isoniazid for 9 months. The prevalence of use and adherence to treatment varied considerably (18% to 100%), and were evaluated by participant completion of isoniazid treatment for latent tuberculosis infection. The adverse events most frequently reported were hepatotoxicity, gastric intolerance, and neuropathy; the rates of occurrence ranged from < 1% to 48%. In the studies that evaluated the effectiveness of isoniazid for latent tuberculosis infection, the rate varied from 0 to 19.7% for patients who did not have active tuberculosis after the follow-up period. CONCLUSIONS The importance of maintaining follow up for patients using isoniazid should be emphasized due to the risk of developing adverse events. Despite the treatment challenges, the rates of patients who used isoniazid and developed active tuberculosis during the follow-up period were low. We believe that isoniazid continues to contribute to tuberculosis control worldwide, and better care strategies are required.
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Affiliation(s)
- Bárbara Manuella Cardoso Sodré-Alves
- Universidade de Brasília, Laboratório de Estudos Farmacêuticos, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Ciências Farmacêuticas, Brasília, DF, Brasil
| | - Melina Mafra Toledo
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
| | - Ivan Ricardo Zimmermann
- Universidade de Brasília, Laboratório de Estudos Farmacêuticos, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
| | - Wildo Navegantes de Araújo
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil
- Universidade de Brasília, Faculdade de Ceilândia, Brasília, DF, Brasil
- Instituto Nacional de Ciência e Tecnologia para Avaliação de Tecnologias em Saúde, Porto Alegre, RS, Brasil
| | - Noemia Urruth Leão Tavares
- Universidade de Brasília, Laboratório de Estudos Farmacêuticos, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Ciências Farmacêuticas, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
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Kota NT, Shrestha S, Kashkary A, Samina P, Zwerling A. The Global Expansion of LTBI Screening and Treatment Programs: Exploring Gaps in the Supporting Economic Evidence. Pathogens 2023; 12:pathogens12030500. [PMID: 36986422 PMCID: PMC10054594 DOI: 10.3390/pathogens12030500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
The global burden of latent TB infection (LTBI) and the progression of LTBI to active TB disease are important drivers of ongoing TB incidence. Addressing LTBI through screening and TB preventive treatment (TPT) is critical in order to end the TB epidemic by 2035. Given the limited resources available to health ministries around the world in the fight against TB, we must consider economic evidence for LTBI screening and treatment strategies to ensure that limited resources are used to achieve the biggest health impact. In this narrative review, we explore key economic evidence around LTBI screening and TPT strategies in different populations to summarize our current understanding and highlight gaps in existing knowledge. When considering economic evidence supporting LTBI screening or evaluating different testing approaches, a disproportionate number of economic studies have been conducted in high-income countries (HICs), despite the vast majority of TB burden being borne in low- and middle-income countries (LMICs). Recent years have seen a temporal shift, with increasing data from low- and middle-income countries (LMICs), particularly with regard to targeting high-risk groups for TB prevention. While LTBI screening and prevention programs can come with extensive costs, targeting LTBI screening among high-risk populations, such as people living with HIV (PLHIV), children, household contacts (HHC) and immigrants from high-TB-burden countries, has been shown to consistently improve the cost effectiveness of screening programs. Further, the cost effectiveness of different LTBI screening algorithms and diagnostic approaches varies widely across settings, leading to different national TB screening policies. Novel shortened regimens for TPT have also consistently been shown to be cost effective across a range of settings. These economic evaluations highlight key implementation considerations such as the critical nature of ensuring high rates of adherence and completion, despite the costs associated with adherence programs not being routinely assessed and included. Digital and other adherence support approaches are now being assessed for their utility and cost effectiveness in conjunction with novel shortened TPT regimens, but more economic evidence is needed to understand the potential cost savings, particularly in settings where directly observed preventive therapy (DOPT) is routinely conducted. Despite the growth of the economic evidence base for LTBI screening and TPT recently, there are still significant gaps in the economic evidence around the scale-up and implementation of expanded LTBI screening and treatment programs, particularly among traditionally hard-to-reach populations.
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Affiliation(s)
| | - Suvesh Shrestha
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Abdulhameed Kashkary
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Public Health Authority, Riyadh 13351, Saudi Arabia
| | - Pushpita Samina
- Center for Health Economics and Policy Analysis, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Alice Zwerling
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
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[Translated article] Tuberculosis contacts tracing in Spain: Cost analysis. Arch Bronconeumol 2022. [PMID: 35623743 DOI: 10.1016/j.arbres.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gullón-Blanco JA, Rodrigo-Sanz T, Tabernero-Huguet E, Sabría-Mestres J, Anibarro L, Villanueva-Montes MÁ, Mir-Viladrich I, Álvarez-Mavarez JD, García-García JM. Tuberculosis Contacts Tracing in Spain: Cost Analysis. Arch Bronconeumol 2022; 58:448-450. [PMID: 35312565 DOI: 10.1016/j.arbres.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- José Antonio Gullón-Blanco
- Unidad de Gestión Clínica Neumología, Hospital Universitario San Agustín, Avilés, España; Programa Integrado de Investigación en Tuberculosis (PII-TB) SEPAR, Barcelona, España.
| | - Teresa Rodrigo-Sanz
- Programa Integrado de Investigación en Tuberculosis (PII-TB) SEPAR, Barcelona, España
| | - Eva Tabernero-Huguet
- Programa Integrado de Investigación en Tuberculosis (PII-TB) SEPAR, Barcelona, España; Servicio de Neumología, Hospital Universitario de Cruces, Baracaldo, España
| | - Josefina Sabría-Mestres
- Programa Integrado de Investigación en Tuberculosis (PII-TB) SEPAR, Barcelona, España; Servicio de Neumología, Hospital Moisés Broggi, Sant Joan Despí, España
| | - Luis Anibarro
- Programa Integrado de Investigación en Tuberculosis (PII-TB) SEPAR, Barcelona, España; Servicio de Medicina Interna, Complexo Hospitalario de Pontevedra, Pontevedra, España
| | - Manuel-Ángel Villanueva-Montes
- Unidad de Gestión Clínica Neumología, Hospital Universitario San Agustín, Avilés, España; Programa Integrado de Investigación en Tuberculosis (PII-TB) SEPAR, Barcelona, España
| | - Isabel Mir-Viladrich
- Programa Integrado de Investigación en Tuberculosis (PII-TB) SEPAR, Barcelona, España; Sección de Neumología, Hospital Son Llatzer, Palma de Mallorca, España
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Patel AR, Campbell JR, Sadatsafavi M, Marra F, Johnston JC, Smillie K, Lester RT. Burden of non-adherence to latent tuberculosis infection drug therapy and the potential cost-effectiveness of adherence interventions in Canada: a simulation study. BMJ Open 2017; 7:e015108. [PMID: 28918407 PMCID: PMC5640098 DOI: 10.1136/bmjopen-2016-015108] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Pharmaceutical treatment of latent tuberculosis infection (LTBI) reduces the risk of progression to active tuberculosis (TB); however, poor adherence tempers the protective effect. We aimed to estimate the health burden of non-adherence, the maximum allowable cost of hypothetical new adherence interventions to be cost-effective and the potential value of existing adherence interventions for patients with low-risk LTBI in Canada. DESIGN A microsimulation model of LTBI progression over 25 years. SETTING General practice in Canada. PARTICIPANTS Individuals with LTBI who are initiating drug therapy. INTERVENTIONS A hypothetical intervention with a range of effectiveness was evaluated. Existing drug adherence interventions including peer support, two-way text messaging support, enhanced adherence counselling and adherence incentives were also evaluated. PRIMARY AND SECONDARY OUTCOME MEASURES Simulation outcomes included healthcare costs, TB incidence, TB deaths and quality-adjusted life years (QALYs). Base case results were interpreted against a willingness-to-pay threshold of $C50 000/QALY. RESULTS Compared with current adherence levels, full adherence to LTBI drug therapy could reduce new TB cases from 90.3 cases per 100 000 person-years to 35.9 cases per 100 000 person-years and reduce TB-related deaths from 7.9 deaths per 100 000 person-years to 3.1 deaths per 100 000 person-years. An intervention that increases relative adherence by 40% would bring the population near full adherence to drug therapy and could have a maximum allowable annual cost of approximately $C450 per person to be cost-effective. Based on estimates of effect sizes and costs of existing adherence interventions, we found that they yielded between 900 and 2400 additional QALYs per million people, reduced TB deaths by 5%-25% and were likely to be cost-effective over 25 years. CONCLUSION Full adherence could reduce the number of future TB cases by nearly 60%, offsetting TB-related costs and health burden. Several existing interventions are could be cost-effective to help achieve this goal.
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Affiliation(s)
- Anik R Patel
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon R Campbell
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - James C Johnston
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Smillie
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard T Lester
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Huang YW, Yang SF, Yeh YP, Tsao TCY, Tsao SM. Impacts of 12-dose regimen for latent tuberculosis infection: Treatment completion rate and cost-effectiveness in Taiwan. Medicine (Baltimore) 2016; 95:e4126. [PMID: 27559940 PMCID: PMC5400306 DOI: 10.1097/md.0000000000004126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Treatment of latent tuberculosis infection (LTBI) is essential for eradicating tuberculosis (TB). Moreover, the patient adherence is crucial in determining the effectiveness of TB control. Isoniazid given by DOTS daily for 9 months (9H) is the standard treatment for LTBI in Taiwan. However, the completion rate is low due to the long treatment period and its side effects. The combined regimen using a high dose of rifapentine/isoniazid once weekly for 12 weeks (3HP) has been used as an alternative treatment option for LTBI in the United States. This may result in a higher completion rate. In this pilot study, patient adherence and cost of these 2 treatment regimens were investigated. Thus, we aimed to assess the treatment completion rate and costs of 3HP and compare to those with 9H.Data from 691 cases of LTBI treatments including 590 cases using the conventional regimen and 101 cases with rifapentine/Isoniazid were collected. The cost was the sum of the cost of treatment with Isoniazid for 9 months or with rifapentin/Isoniazid for 3 months of all contacts. The effectiveness was the cost of cases of tuberculosis avoided.In this study, the treatment completion rate for patients prescribed with the 3 months rifapentine/isoniazid regimen (97.03%) was higher than those given the conventional 9-month isoniazid regimen (87.29%) (P <0.001). The cost of 3HP and 9H was US$261.24 and US$717.3, respectively. The cost-effectiveness ratio with isoniazid for 9 months was US$ 15392/avoided 1 case of tuberculosis and US$ 5225/avoided 1 case of tuberculosis with 3HP. In addition, when compared with the conventional regimen, there were fewer patients discontinued with rifapentine/isoniazid regimen due to undesirable side effects.This was the first study to compare the 2 treatment regimens in Taiwan, and it showed that a short-term high-dosage rifapentine/isoniazid treatment regimen reduced costs and resulted in higher treatment completion than the standard LTBI isoniazid treatment.
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Affiliation(s)
- Yi-Wen Huang
- Institute of Medicine, Chung Shan Medical University, Taichung
- Pulmonary and Critical Care Unit, Changhua Hospital, Department of Health, Changhua
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung
| | | | - Thomas Chang-Yao Tsao
- Institute of Medicine, Chung Shan Medical University, Taichung
- Division of Chest, Department of Internal Medicine, Chung Shan Medical University Hospital
| | - Shih-Ming Tsao
- Division of Chest, Department of Internal Medicine, Chung Shan Medical University Hospital
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
- Correspondence: Shih-Ming Tsao, 110 Chien-Kuo N. Road, Section 1, Taichung 40201, Taiwan (e-mail: )
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