Health-Related Quality of Life (HRQoL) scores vary with treatment and may identify potential defaulters during treatment of tuberculosis

The Cost-Effectiveness of the BEAT-TB Regimen for Pre-Extensively Drug-Resistant TB

OBJECTIVE

To measure the economic impacts of the longer pre-XDR-TB treatment regimen and the shorter BEAT-TB India regimen.

METHODS

In the current study, the economic impacts of the current 18-month pre-XDR-TB treatment regimen and the 6-9 month BEAT-TB regimen were evaluated using an economic model via a decision tree analysis from a societal perspective. The incremental costs and quality-adjusted life years (QALYs) gained from the introduction of the BEAT-TB regimen for pre-XDR-TB patients were estimated.

RESULTS

For a cohort of 1000 pre-XDR-TB patients, we found that the BEAT-TB India regimen yielded higher undiscounted life years (40,548 vs. 21,009) and more QALYs gained (27,633 vs. 15,812) than the 18-month regimen. The BEAT-TB India regimen was found to be cost-saving, with an incremental cost of USD -128,651 when compared to the 18-month regimen. The current analysis did not consider the possibility of reduced TB recurrence after use of the BEAT-TB regimen, so it might have under-estimated the benefits.

CONCLUSION

As a lower-cost intervention with improved health outcomes, the BEAT-TB India regimen is dominant when compared to the 18-month regimen.

Correlates of quality of life among persons living with tuberculosis: A cross-sectional study

Introduction

The correlates of quality of life originating from the demographic characteristics, comorbidities and sources of social support among persons living with tuberculosis remain underreported. The aim of this study was to examine the correlates of quality of life among persons living with tuberculosis within Greater Accra, Ghana.

Methods

A cross-sectional survey design was used to assess the correlates of quality of life among 250 randomly sampled persons living with tuberculosis. Quality of life was assessed with the Quality of Life Brief Version (WHOQOL-BREF) questionnaire and correlates were derived using Spearman rho correlations. Chi-square analyses assessed associations among respondent characteristics.

Results

All four quality of life domains (physical, psychological, social relationship and environmental) of persons living with tuberculosis were positively correlated. Furthermore, receiving social support from family or friends correlated positively with respondents’ quality of life. Human Immunodeficiency Virus (HIV) infection and receiving social support mainly from work colleagues or religious institutions correlated negatively with respondents’ quality of life domains. Other correlates of quality of life included age, pleuritis with pleural effusion, number of dependants and distance to tuberculosis treatment centres. Social support from family and friends corresponded with better quality of life among persons living with tuberculosis.

Conclusion

The quality of life domains of persons living with tuberculosis are interrelated and can be enhanced by social support. Healthcare providers should involve the significant others of persons living with tuberculosis, human immunodeficiency virus and pleuritis with pleural effusion in their care to promote patients’ quality of life.

Cost Effectiveness of a Shorter Moxifloxacin Based Regimen for Treating Drug Sensitive Tuberculosis in India

Globally efforts are underway to shorten the existing 6-month tuberculosis (TB) treatment regimen for drug-sensitive patients, which would be equally effective and safe. At present, there is a lack of evidence on the cost implications of a shorter 4-month TB regimen in India. This economic modeling study was conducted in the Indian context with a high TB burden. We used a hybrid economic model comprising of a decision tree and Markov analysis. The study estimated the incremental costs, life years (LYs), and quality-adjusted life years (QALYs) gained by the introduction of a Moxifloxacin-based shorter 4-month treatment regimen for pulmonary TB patients. The outcomes are expressed in incremental cost-effectiveness ratios (ICERs) per QALYs gained. The cost per case to be treated under the 4-month regimen was USD 145.94 whereas for the 6-month regimen it was USD 150.39. A shorter 4-month TB regimen was cost-saving with USD 4.62 per LY and USD 5.29 per QALY. One-way sensitivity analysis revealed that the cost of the drugs for the 4-month regimen, hospitalization cost for adverse drug reactions, and human resources incurred for the 6-month regimen had a higher influence on the ICER. The probability sensitivity analysis highlighted that the joint incremental cost and effectiveness using QALY were less costly and more effective for 67% of the iteration values. The cost-effectiveness acceptability curve highlights that the 4-month regimen was dominant to both patients and the National TB Elimination Programme in India as compared to the 6-month regimen at different cost-effectiveness threshold values.

Health-Related Quality of Life (HRQoL) of Patients with Tuberculosis: A Review

Tuberculosis (TB) is a major killer and cause of human suffering worldwide and imposes a substantial reduction in patients’ health-related quality of life (HRQoL). HRQoL indicates the consciousness of patients regarding their physical and mental health. It is, therefore, very relevant in comprehending and measuring the exact impact of the disease state. Therefore, we undertook this review to summarize the available evidence on the impact of TB and its treatment on HRQoL. An in-depth understanding of HRQoL in TB patients can identify the existing management gaps. We undertook a systematic search through PubMed and CENTRAL. Data were extracted and tabulated for study design, targeted population, QoL instrument used, QoL domain assessed, and key findings. We included studies that assessed the effect of TB on the QoL both during and after treatment. There are no specific HRQoL assessment tools for utilization among TB patients. HRQoL is markedly impaired in patients with TB. The factors affecting HRQoL differ with active and latent TB, socio-demographics, socio-economic status, presence of co-infections, etc. This review’s findings can help to frame appropriate policies for tackling HRQoL issues in TB patients.

Prospective Evaluation of Positivity Rates of Aspergillus-Specific IgG and Quality of Life in HIV-Negative Tuberculosis Patients in Lagos, Nigeria

Background

Pulmonary tuberculosis (PTB) often results in residual anatomical and functional changes despite microbiological cure and may be complicated by chronic pulmonary aspergillosis (CPA). In this study, we determined the perceived health-related quality of life (HRQoL) of patients during and after PTB therapy and compared it with their quantitative Aspergillus-specific IgG positivity rates.

Methodology

We conducted a longitudinal study among TB patients attending two directly observed therapy short-course (DOTS) clinics in Lagos, Nigeria. Two hundred and four confirmed TB patients were recruited over 9 months, with five visits at baseline and 3, 6, 9, and 12 months. They were all acid-fast bacilli smear, GeneXpert, or culture positive for Mycobacterium tuberculosis. Two HRQoL questionnaires translated into Yoruba were self-administered. Chest X-ray and Aspergillus IgG were collected at each visit.

Results

A total of 204 participants were recruited into this study. Most (70.6%) were age 18–39 years, and only 3.9% were above 60 years; 66.7% of all participants were males. A total of 189 (92.6%) participated in the 3-month assessment, 174 (85.3%) at 6 months, 139 (68.1%) at 9 months, and 99 (48.5%) at 12 months. At baseline, only 60.9% scored “good” or “very good” QoL and health on the WHOQOL-Bref, which improved to 77% at 6 months. At baseline, 10.4% had positive Aspergillus IgG levels, 15.1% at 3 months, 11.5% at 6 months, 16.7% at 9 months, and 19.3% at 12 months. Those with a positive Aspergillus IgG at 6 months had worse physical health (p = 0.001), psychological state (p = 0.002), social relationships (p = 0.006), and environmental QoL (p = 0.001) domains of the WHOQOL-Bref. Probable CPA was 10.4% at baseline and 19.3% at 6 months post-PTB therapy. Thirty-eight (18.6%) relocated after 6 months of treatment, 16 (7.8%) were lost to follow-up, and 11 (5.4%) died.

Conclusion

Our findings reveal a significant relationship between the QoL and Aspergillus IgG levels of TB patients. Further follow-up studies and additional imaging are required to determine when patients develop CPA and its clinical impact.

Prevalence of depression and anxiety among drug resistant tuberculosis: A study in North India

BACKGROUND

Drug Resistant Tuberculosis (DR-TB) is an emergent issue in the recent decades. Multidrug resistant (MDR-TB) and Extensive drug resistant (XDR-TB) tuberculosis are the common type of DR-TB. Psychological issues like depression and anxiety are common among the chronic illnesses like tuberculosis. This study aimed at estimating the prevalence of depression and anxiety among these patients.

METHODS

Our study is conducted in a tertiary care teaching hospital in North India. This study aimed at identifying the prevalence of depression and anxiety among the drug resistant tuberculosis patients attending DOTS clinic. The depression and anxiety were screened using PHQ-9 and HAM-A inventories. Binomial and multinomial regression analysis were done to identifying the predictors of depression and anxiety.

RESULTS

The prevalence rate of depression in MDR-TB and XDR-TB is 68% and 78% respectively. The prevalence of anxiety is 54% in MDR-TB and 66% in XDR-TB respectively in our study. Duration of illness and literacy were the significant predictors of depression and anxiety.

CONCLUSION

Patients with DR-TB faces huge psychological burden and this study highlighted the toll of depression and anxiety among them. Adequate screening, identification and treatment for these disorders among DR-TB patients at their earlier treatment stage helps in improving the adherence to treatment and functionality.

Performance assessment of SD Bioline TB MPT64 assay for the diagnosis of Mycobacterium tuberculosis complex in Lagos, Nigeria

This study assessed the performance of SD Bioline MPT64 immunochromatographic test for the identification of Mycobacterium tuberculosis complex (MTBC) in Nigeria.A total of 157 mycobacterial isolates, comprising 120 (76.4%) MTBC (M. tuberculosis, 112; M. africanum, 5; M. bovis, 3) and 37 (23.6%) non-tuberculous mycobacteria (NTM) isolates from patients attending six DOTS centers in Lagos between June 2012 and July 2014 were analyzed. All the isolates were grown on Bactec MGIT960 liquid media and identified in parallel by the conventional method and MPT64 immunochromatographic test. Discrepant results were resolved using the line probe assay.The comorbid disease rates for HIV and type 2 diabetes were 20.9% and 8.2%, respectively. Compared to the conventional method, SD Bioline MPT64 identified 117 MTBC isolates correctly, producing a sensitivity of 97.5% (95% CI, 92.9-99.2) at a shorter growing median time of 11 days compared to 26 days by the conventional method. The three undetected MTBC were confirmed by the line probe assay to be M. tuberculosis strains. The test also identified all the NTM correctly producing a specificity of 100% (95% CI, 90.7-100).This study supports the integration of SD Bioline TB MPT64 antigen test into diagnostic workflow for rapid MTBC case identification in Nigeria.

Impact of metformin therapy on health-related quality of life outcomes in tuberculosis patients with diabetes mellitus in India: A prospective study

OBJECTIVE

To assess the impact of metformin use on health-related quality of life (HRQoL) in tuberculosis (TB) patients who are presented with type 2 diabetes mellitus (T2DM).

METHODOLOGY

In this community-based prospective study, TB patients attending Hakeem Abdul Hameed Centenary Hospital, New Delhi (India) and had comorbidity of T2DM between April 2018 and July 2019 were enrolled. Patients were divided into metformin users and metformin non-users on the basis of the presence of metformin in their routine as antidiabetic drug(s). HRQoL was determined using a validated TB-specific tool (Dhingra and Rajpal-12 scale ie, DR-12) consists of symptom and socio-psychological and exercise adaptation domains. The HRQoL scores were compared at pretreatment (1st visit), end of intensive phase (2nd visit) and end of treatment (3rd visit) between the two groups.

RESULTS

A total of 120 patients were enrolled, of which 24 were excluded as they did not respond at follow-up visits. Among the metformin users (n = 48) the mean age of patients was 47.56 years and 62.50% was males. Among the metformin non-users (n = 48), the mean age of patients was 49.02 years and 54.10% was males. The baseline characteristics were similar in both groups except for the substance used history (P = .025), literacy level (P = .048) and BMI (P = .028). Metformin users demonstrated significant improvement in symptom scores (2nd visit: P < .001; 3rd visit: P = .001) and socio-psychological and exercise adaptation scores (2nd visit: P < .0001; 3rd visit: P < .0001) as compared with metformin non-users at 2nd visit and 3rd visit. Overall, scores were also found to be significantly improved in metformin users (2nd visit: P < .001; 3rd visit: P = .001).

CONCLUSION

Metformin therapy exerted favourable effects on HRQoL in patients with TB and T2DM and can be recommended as an adjuvant antitubercular drug in TB patients with co-morbidity of T2DM, unless contraindicated.