Evaluating the cost-effectiveness of levofloxacin therapy for household contacts of multidrug-resistant tuberculosis in Vietnam

TL;DR

This study shows that using levofloxacin to prevent TB in household contacts of drug-resistant TB patients in Vietnam is cost-saving and effective.

Contribution

The study evaluates the cost-effectiveness of 6Lfx therapy for MDR/RR-TB contacts in a resource-limited setting for the first time.

Findings

6Lfx therapy saved costs and gained 40.1 QALYs per 1000 population over 20 years.

19.9 MDR/RR-TB cases and 3.2 deaths were averted per 1000 people treated with 6Lfx.

The strategy is cost-saving in preventing active TB in high-risk contacts.

Abstract

Multidrug-resistant tuberculosis (TB) threatens global TB control, on account of poor treatment outcomes, high treatment toxicity and costs. Recent trials demonstrated the effectiveness of six-months of levofloxacin (6Lfx) to prevent TB disease among high-risk contacts. However, the cost-effectiveness of this strategy has not previously been evaluated.

The VQUIN study was a double-blinded randomised control trial in Vietnam assessing the effectiveness of 6Lfx in household contacts of multidrug resistant/rifampicin resistant TB (MDR/RR-TB) to prevent progression to TB disease. Incorporating in-trial costs and effectiveness outcomes from the VQUIN trial, we developed a closed cohort, decision-analytic Markov model to assess the cost effectiveness of 6Lfx versus placebo in a cohort exposed to MDR/RR-TB in Vietnam.

Over a 20-year time horizon, the provision of 6Lfx preventative therapy to household contacts of people infected with MDR/RR-TB was found to gain a total of 40.1 QALYs per 1000 population and save US$23,145 per 1000 population, indicating the strategy was cost saving. MDR/RR-TB cases averted over 20 years was 19.9 per 1000 population treated with 6Lfx, and the number of deaths averted was 3.2 per 1000 people treated.

6Lfx therapy is a cost-saving strategy to reduce the incidence of active disease in household contacts of MDR/RR-TB in a resource-limited setting.

10.13039/501100000925National Health and Medical Research Council Project Grant (#1081443). GJF was supported by a NHMRC Leadership Fellowship (Level 1) (#2007920).

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