Cost-Effectiveness of Levofloxacin for Tuberculosis Prevention in MDR/RR-TB Contacts in High-Burden Settings
Author(s)
Ginenus Fekadu, PhD1, Tadesse Tolossa, MPH2, Tesfaye Regassa Feyissa, PhD3, Martin Siegel, PhD4, Wai-kit Ming, PhD, MD5.
1Pharmacy, Wollega University, Nekemte, Ethiopia, 2Deakin Health Economics, Deakin University, Melbourne, Australia, 3Deakin Rural Health, Deakin University, Melbourne, Australia, 4Empirical Health Economics, Technische Universität Berlin, Berlin, Germany, 5Infectious Diseases and Public Health, City University of Hong Kong, City University of Hong Kong, Hong Kong.
1Pharmacy, Wollega University, Nekemte, Ethiopia, 2Deakin Health Economics, Deakin University, Melbourne, Australia, 3Deakin Rural Health, Deakin University, Melbourne, Australia, 4Empirical Health Economics, Technische Universität Berlin, Berlin, Germany, 5Infectious Diseases and Public Health, City University of Hong Kong, City University of Hong Kong, Hong Kong.
OBJECTIVES: Multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) significantly challenges global health, particularly in high-burden settings like South Africa. Contacts of MDR/RR-TB patients face a heightened risk of developing tuberculosis (TB) disease, yet effective preventive strategies are limited. Recent clinical trials have demonstrated that a six-month levofloxacin preventive therapy (LPT) can significantly reduce TB incidence among high-risk contacts. This study evaluates the cost-effectiveness of LPT from the South African healthcare provider’s perspective, aiming to inform scalable strategies for MDR/RR-TB contacts.
METHODS: A decision-analytic model was constructed, combining a short-term decision tree with a 10-year time horizon using annual cycles within a Markov cohort. This model simulated potential treatment outcomes for LPT compared to no preventive therapy (NPT) among hypothetical contacts of confirmed MDR/RR-TB index cases. Primary outcomes included medical costs, quality-adjusted life years (QALYs), mortality, and TB incidences. Model parameters were sourced from published literature and recent public data. The base case was calculated using incremental cost-effectiveness ratios (ICERs), and sensitivity analyses were conducted to assess the robustness of the results.
RESULTS: In the base case, LPT was cost-effective, with an ICER of $3,610/QALY at a willingness-to-pay (WTP) threshold of $6,023/QALY. Compared to NPT, LPT averted 8.9 TB-related deaths (9.4%) and 27.1 TB incidences (18.0%) per 1,000 contacts over 10 years. One-way sensitivity analyses indicated that LPT remained cost-effective when efficacy in reducing TB incidence exceeded 42.80% (base-case efficacy: 59%). The maximum price threshold for LPT per case to achieve cost neutrality was $447 (base-case cost: $321). In 10,000 Monte Carlo probabilistic simulations, the probability of LPT being cost-effective was 74% at the $6,023/QALY threshold.
CONCLUSIONS: LPT significantly reduces TB incidence and mortality among MDR/RR-TB contacts and is cost-effective, supporting its integration into national TB control programs for high-risk populations. Robust screening and follow-up protocols are essential to maximize effectiveness.
METHODS: A decision-analytic model was constructed, combining a short-term decision tree with a 10-year time horizon using annual cycles within a Markov cohort. This model simulated potential treatment outcomes for LPT compared to no preventive therapy (NPT) among hypothetical contacts of confirmed MDR/RR-TB index cases. Primary outcomes included medical costs, quality-adjusted life years (QALYs), mortality, and TB incidences. Model parameters were sourced from published literature and recent public data. The base case was calculated using incremental cost-effectiveness ratios (ICERs), and sensitivity analyses were conducted to assess the robustness of the results.
RESULTS: In the base case, LPT was cost-effective, with an ICER of $3,610/QALY at a willingness-to-pay (WTP) threshold of $6,023/QALY. Compared to NPT, LPT averted 8.9 TB-related deaths (9.4%) and 27.1 TB incidences (18.0%) per 1,000 contacts over 10 years. One-way sensitivity analyses indicated that LPT remained cost-effective when efficacy in reducing TB incidence exceeded 42.80% (base-case efficacy: 59%). The maximum price threshold for LPT per case to achieve cost neutrality was $447 (base-case cost: $321). In 10,000 Monte Carlo probabilistic simulations, the probability of LPT being cost-effective was 74% at the $6,023/QALY threshold.
CONCLUSIONS: LPT significantly reduces TB incidence and mortality among MDR/RR-TB contacts and is cost-effective, supporting its integration into national TB control programs for high-risk populations. Robust screening and follow-up protocols are essential to maximize effectiveness.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE258
Topic
Clinical Outcomes, Economic Evaluation, Health Policy & Regulatory
Disease
Infectious Disease (non-vaccine), Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)