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Cost-effectiveness of latent tuberculosis infection testing and treatment with 6-week regimen among key population in rural communities in China: a decision analysis study

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Abstract

Purpose

Several model studies suggested the implementation of latent tuberculosis infection (LTBI) testing and treatment could greatly reduce the incidence of tuberculosis (TB) and achieve the 2035 target of the “End TB” Strategy in China. The present study aimed to evaluate the cost-effectiveness of LTBI testing and TB preventive treatment among key population (≥ 50 years old) susceptible to TB at community level in China.

Methods

A Markov model was developed to investigate the cost-effectiveness of LTBI testing using interferon gamma release assay (IGRA) and subsequent treatment with 6-month daily isoniazid regimen (6H) (as a standard regimen for comparison) or 6-week twice-weekly rifapentine and isoniazid regimen (6-week H2P2) in a cohort of 10,000 adults with an average initial age of 50 years.

Results

In the base-case analysis, LTBI testing and treatment with 6H was dominated (i.e., more expensive with a lower quality-adjusted life year (QALY)) by LTBI testing and treatment with 6-week H2P2. LTBI testing and treatment with 6-week H2P2 was more effective than no intervention at a cost of $20,943.81 per QALY gained, which was below the willingness-to-pay (WTP) threshold of $24,211.84 per QALY gained in China. The one-way sensitivity analysis showed the change of LTBI prevalence was the parameter that most influenced the results of the incremental cost-effectiveness ratios (ICERs).

Conclusion

As estimated by a Markov model, LTBI testing and treatment with 6-week H2P2 was cost-saving compared with LTBI testing and treatment with 6H, and it was considered to be a cost-effective option for TB control in rural China.

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Data availability

The datasets used for this study are available on request from the corresponding authors.

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Funding

This work was supported by the National Key R&D Program of China (2022YFC2303202) and the CAMS Innovation Fund for Medical Sciences (2021-I2M-1–037).

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Authors and Affiliations

  1. NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People’s Republic of China

    Xuefang Cao, Tonglei Guo, Henan Xin, Jiang Du, Boxuan Feng, Yijun He, Lingyu Shen, Yuanzhi Di, Zihan Li, Jianguo Liang, Qi Jin & Lei Gao

  2. Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People’s Republic of China

    Xuefang Cao, Tonglei Guo, Henan Xin, Jiang Du, Boxuan Feng, Yijun He, Lingyu Shen, Yuanzhi Di, Zihan Li, Jianguo Liang, Qi Jin & Lei Gao

  3. Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, 100005, Beijing, China

    Chenlu Yang & Li Wang

  4. Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, Key Laboratory of Tropical Translational Medicine of Ministry of Education, Hainan Medical University, 571199, Haikou, China

    Zihan Li

  5. College of Public Health, Zhengzhou University, 450001, Zhengzhou, China

    Yanxiao Chen

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  1. Xuefang Cao
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  2. Tonglei Guo
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Contributions

LG and LW were responsible for study conception. XFC, TLG, LG, and LW planned and designed the study. XFC, TLG, HNX, JD, CLY, BXF, YJH, LYS, YZD, ZHL, YXC, JGL, QJ, LW, and LG contributed to the data acquisition. XFC conducted the analysis with TLG and CLY support. XFC drafted the manuscript. All authors reviewed the manuscript for scientific content and approved the final manuscript.

Corresponding authors

Correspondence to Li Wang or Lei Gao.

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As human subjects were not involved, ethics approval was not required for this study.

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The authors declare no competing interests.

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Xuefang Cao and Tonglei Guo contributed equally to the article.

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Cao, X., Guo, T., Xin, H. et al. Cost-effectiveness of latent tuberculosis infection testing and treatment with 6-week regimen among key population in rural communities in China: a decision analysis study. Eur J Clin Microbiol Infect Dis (2024). https://doi.org/10.1007/s10096-024-04777-z

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