Economic Evaluation of Whole Genome Sequencing Guided Treatment for Rifampicin-Resistant Tuberculosis: A Within-Trial Analysis of the SMARTT Trial
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healthcareType de record:
paper
Créateur:
ZhiLanFelEmi
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Background: Whole genome sequencing (WGS) can guide effective rifampicin-resistant tuberculosis (RR-TB) treatment but the cost is a perceived barrier.
Methods: We performed a health-economic evaluation of culture-based WGS combined with automated recommendation for an all-oral 6-month individualized regimen. Provider, patient and household costs for RR-TB management were analyzed for 203 participants randomized to the WGS intervention or standard of care (SOC) in the South African SMARTT trial (Sept 2021-Feb 2023). Cost-effectiveness was assessed by incremental cost-effectiveness ratio (ICER); monetary value by Incremental Net Monetary Benefit (INMB) and Return on Investment (ROI).
Findings: WGS-guided treatment was dominant, reducing the per patient mean total cost (-$370) and increasing the per patient health benefit (-0.05 DALYs), resulting in an INMB of $618. Society gained $3.61 for every dollar invested. Among people living with HIV, WGS-guided treatment resulted in greater cost reduction (-$582 vs -$22), greater DALY reduction (-0.08 vs -0.01) and higher INMB ($969 vs $51). The benefit was larger for women than men (cost savings $694 vs $191, DALY reduction -0.06 vs -0.03, and INMBs $997 vs $319). People with expanded resistance experienced the greatest health benefit (0.46 DALYs averted), but the intervention was not cost-effective in this population (INMB $-1231) due to higher drug ($1690 vs $1260) and inpatient costs ($4,244 vs $1,201).
Interpretation: WGS-guided RR-TB treatment was cost-effective and society gained $3.6 benefit for every dollar invested. Future research should evaluate the cost-effectiveness of WGS-guided treatment in contexts where an all-oral 6-month regimen is the SOC.
Methods: We performed a health-economic evaluation of culture-based WGS combined with automated recommendation for an all-oral 6-month individualized regimen. Provider, patient and household costs for RR-TB management were analyzed for 203 participants randomized to the WGS intervention or standard of care (SOC) in the South African SMARTT trial (Sept 2021-Feb 2023). Cost-effectiveness was assessed by incremental cost-effectiveness ratio (ICER); monetary value by Incremental Net Monetary Benefit (INMB) and Return on Investment (ROI).
Findings: WGS-guided treatment was dominant, reducing the per patient mean total cost (-$370) and increasing the per patient health benefit (-0.05 DALYs), resulting in an INMB of $618. Society gained $3.61 for every dollar invested. Among people living with HIV, WGS-guided treatment resulted in greater cost reduction (-$582 vs -$22), greater DALY reduction (-0.08 vs -0.01) and higher INMB ($969 vs $51). The benefit was larger for women than men (cost savings $694 vs $191, DALY reduction -0.06 vs -0.03, and INMBs $997 vs $319). People with expanded resistance experienced the greatest health benefit (0.46 DALYs averted), but the intervention was not cost-effective in this population (INMB $-1231) due to higher drug ($1690 vs $1260) and inpatient costs ($4,244 vs $1,201).
Interpretation: WGS-guided RR-TB treatment was cost-effective and society gained $3.6 benefit for every dollar invested. Future research should evaluate the cost-effectiveness of WGS-guided treatment in contexts where an all-oral 6-month regimen is the SOC.
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