Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis.
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.A computerized Markov model to analyz...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2012-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3260212?pdf=render |
| _version_ | 1818421759154585600 |
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| author | David P Holland Gillian D Sanders Carol D Hamilton Jason E Stout |
| author_facet | David P Holland Gillian D Sanders Carol D Hamilton Jason E Stout |
| author_sort | David P Holland |
| collection | DOAJ |
| description | 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.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.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."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. |
| first_indexed | 2024-12-14T13:15:28Z |
| format | Article |
| id | doaj.art-87f5b154989847f7a9fbe7ac548aa1aa |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-14T13:15:28Z |
| publishDate | 2012-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-87f5b154989847f7a9fbe7ac548aa1aa2022-12-21T23:00:04ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0171e3019410.1371/journal.pone.0030194Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis.David P HollandGillian D SandersCarol D HamiltonJason E StoutThe 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.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.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."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.http://europepmc.org/articles/PMC3260212?pdf=render |
| spellingShingle | David P Holland Gillian D Sanders Carol D Hamilton Jason E Stout Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. PLoS ONE |
| title | Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
| title_full | Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
| title_fullStr | Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
| title_full_unstemmed | Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
| title_short | Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis. |
| title_sort | strategies for treating latent multiple drug resistant tuberculosis a decision analysis |
| url | http://europepmc.org/articles/PMC3260212?pdf=render |
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