Сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistance
Objective: analysis of clinical and economic efficiency of various etiotropic chemotherapy regimes in patients with respiratory tuberculosis with multidrug- and extensively drug-resistant (MDR and XDR) pathogen using the pharmacoeconomic modeling method (Markov model).Material and methods. A single-...
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| Language: | Russian |
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IRBIS LLC
2023-07-01
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| Series: | Фармакоэкономика |
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| Online Access: | https://www.pharmacoeconomics.ru/jour/article/view/830 |
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| author | N. Yu. Nikolenko D. A. Kudlay S. E. Borisov T. E. Sannikova N. P. Doktorova |
| author_facet | N. Yu. Nikolenko D. A. Kudlay S. E. Borisov T. E. Sannikova N. P. Doktorova |
| author_sort | N. Yu. Nikolenko |
| collection | DOAJ |
| description | Objective: analysis of clinical and economic efficiency of various etiotropic chemotherapy regimes in patients with respiratory tuberculosis with multidrug- and extensively drug-resistant (MDR and XDR) pathogen using the pharmacoeconomic modeling method (Markov model).Material and methods. A single-centre, observational, retrospective, cohort study was performed, which included patients who received treatment in clinics and affiliated organizations of the main Moscow tuberculosis institution during 2014–2019 regarding respiratory tuberculosis with the MDR/XDR pathogen. The data of 1387 patients were analysed, of which 1093 patients received “optimized basic regimen” (OBR) in accordance with the Federal Clinical Recommendations of 2015, 294 patients received etiotropic therapy in accordance with the recommendations of the World Health Organization of 2018–2019. To evaluate economic efficiency, the pharmacoeconomic costeffectiveness analysis and pharmacoeconomic modeling were used. When assessing the economic costs of treatment, the direct costs (medical and non-medical) were taken into account.Results. The study results showed that 68.4% of patients in the group with bedaquiline-containing chemotherapy regimens reached the outcome of “treatment successfully completed” (patient was cured or transfered into the III group of dispensary follow-up) compared to 51.8% in the OBR group. The use of “new” etiotropic therapy regimens is most economically justified in patients with ХDR-tuberculosis with repeated treatment courses: incremental cost-effectiveness ratios (ICER) were 24,530.20 and 21,526.50 rubles per 1 patient. Markov model was developed, transitions from one state to another were evaluated according to the results of clinical observations during the first 2 years of research.Conclusion. The use of the dynamic model of the patient state made it possible to refine the estimates of the effectiveness of the compared etiotropic chemotherapy regimens for tuberculosis with MDR/XDR pathogen. Based on the results of modeling the dynamics of patients in the interval of 2 to 10 years of treatment, the use of “new” regimens provides a significant increase in the proportion of treatment success (by 16.1–29.8% in different groups of patients and at different times), a decrease in mortality (by 6.1–11.0%), and in the proportion of those who interrupted treatment (by 8.0–21.8%) in comparison with OBR. |
| format | Article |
| id | doaj-art-ea1ef39601cd48b480cd3c23bceb4b9c |
| institution | DOAJ |
| issn | 2070-4909 2070-4933 |
| language | Russian |
| publishDate | 2023-07-01 |
| publisher | IRBIS LLC |
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| series | Фармакоэкономика |
| spelling | doaj-art-ea1ef39601cd48b480cd3c23bceb4b9c2025-08-20T03:19:20ZrusIRBIS LLCФармакоэкономика2070-49092070-49332023-07-0116216217510.17749/2070-4909/farmakoekonomika.2023.179437Сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistanceN. Yu. Nikolenko0D. A. Kudlay1S. E. Borisov2T. E. Sannikova3N. P. Doktorova4Moscow Scientific and Practical Center for Tuberculosis ControlI.M. Sechenov First Moscow State Medical University (Sechenov University); Institute of Immunology, Federal Medical and Biological Agency of RussiaMoscow Scientific and Practical Center for Tuberculosis ControlMarchuk Institute of Numerical Mathematics, Russian Academy of SciencesNational Medical Research Center for Phthisiopulmonology and Infectious DiseasesObjective: analysis of clinical and economic efficiency of various etiotropic chemotherapy regimes in patients with respiratory tuberculosis with multidrug- and extensively drug-resistant (MDR and XDR) pathogen using the pharmacoeconomic modeling method (Markov model).Material and methods. A single-centre, observational, retrospective, cohort study was performed, which included patients who received treatment in clinics and affiliated organizations of the main Moscow tuberculosis institution during 2014–2019 regarding respiratory tuberculosis with the MDR/XDR pathogen. The data of 1387 patients were analysed, of which 1093 patients received “optimized basic regimen” (OBR) in accordance with the Federal Clinical Recommendations of 2015, 294 patients received etiotropic therapy in accordance with the recommendations of the World Health Organization of 2018–2019. To evaluate economic efficiency, the pharmacoeconomic costeffectiveness analysis and pharmacoeconomic modeling were used. When assessing the economic costs of treatment, the direct costs (medical and non-medical) were taken into account.Results. The study results showed that 68.4% of patients in the group with bedaquiline-containing chemotherapy regimens reached the outcome of “treatment successfully completed” (patient was cured or transfered into the III group of dispensary follow-up) compared to 51.8% in the OBR group. The use of “new” etiotropic therapy regimens is most economically justified in patients with ХDR-tuberculosis with repeated treatment courses: incremental cost-effectiveness ratios (ICER) were 24,530.20 and 21,526.50 rubles per 1 patient. Markov model was developed, transitions from one state to another were evaluated according to the results of clinical observations during the first 2 years of research.Conclusion. The use of the dynamic model of the patient state made it possible to refine the estimates of the effectiveness of the compared etiotropic chemotherapy regimens for tuberculosis with MDR/XDR pathogen. Based on the results of modeling the dynamics of patients in the interval of 2 to 10 years of treatment, the use of “new” regimens provides a significant increase in the proportion of treatment success (by 16.1–29.8% in different groups of patients and at different times), a decrease in mortality (by 6.1–11.0%), and in the proportion of those who interrupted treatment (by 8.0–21.8%) in comparison with OBR.https://www.pharmacoeconomics.ru/jour/article/view/830respiratory tuberculosismycobacterium tuberculosismbtmultidrug-resistant pathogenmdrextensively drug-resistant pathogenxdrcost-effectiveness analysismarkov modelbedaquiline |
| spellingShingle | N. Yu. Nikolenko D. A. Kudlay S. E. Borisov T. E. Sannikova N. P. Doktorova Сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistance Фармакоэкономика respiratory tuberculosis mycobacterium tuberculosis mbt multidrug-resistant pathogen mdr extensively drug-resistant pathogen xdr cost-effectiveness analysis markov model bedaquiline |
| title | Сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistance |
| title_full | Сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistance |
| title_fullStr | Сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistance |
| title_full_unstemmed | Сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistance |
| title_short | Сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistance |
| title_sort | сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistance |
| topic | respiratory tuberculosis mycobacterium tuberculosis mbt multidrug-resistant pathogen mdr extensively drug-resistant pathogen xdr cost-effectiveness analysis markov model bedaquiline |
| url | https://www.pharmacoeconomics.ru/jour/article/view/830 |
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