Denholm JT 1,2,3, McBryde ES 4, Eisen D 4,5, Street A 2, Matchett E 2, Chen C 6, Shultz TR 2, Biggs B 2, Leder K 2,7. SIRCLE: a randomised controlled cost comparison of self‐administered short‐course isoniazid and rifapentine for cost‐effective latent tuberculosis eradication. Intern Med J. 2017 Dec;47(12):1433-1436. doi: 10.1111/imj.13601.
Currently, treatment of latent tuberculosis infection (LTBI) in Australia consists most commonly of a 9-month course of isoniazid (9H). A 3-month course of weekly isoniazid and rifapentine (3HP) has been shown to be as effective as 9 months of daily isoniazid, and associated with less hepatotoxicity; however, rifapentine is not currently available in Australia. Introduction of this regimen would have apparent advantages for people with LTBI in Victoria by safely shortening duration of LTBI therapy. However, the cost benefit of this new therapeutic approach is uncertain.
Cost-analysis of standard and short-course therapy for LTBI in an Australian context.
Single-centre randomised controlled trial conducted between December 2013-March 2016. Participants underwent 1:1 randomisation to either a 9-month course of daily isoniazid or a 12-week course of weekly isoniazid and rifapentine. The primary outcome measure was total healthcare system costs (in Australian dollars; AUD) per completed course of LTBI therapy. Secondary cost analyses were performed to consider varying assumptions regarding commercial cost of rifapentine.
Overall, 34 of 40 (85%) participants in the 9H group and 36/40 (90%) in the 3HR group completed therapy. One patient in the 3HP group was hospitalised for a febrile illness; no hospitalisations were recorded in the 9H group. The cost per completed course of 9H was 601 AUD, while that of 3HP was significantly lower at 511 AUD (P < 0.01).
This study provides cost analysis evidence to support the use of 3HP for the treatment of LTBI in Australia.