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EFFECTIVE
TUBERCULOSIS
TREATMENT
[Pick the date]
Finding the Most Effective and Cost Effective
Dan Dinh
To TB Treatment Programs in Underdeveloped
Countries
Effective Tuberculosis Treatment
Table of Contents
INTRO
INTRODUCTION
2
METHODOLOGY
STEP-BY-STEP PLAN
2-3
RESULTS
RESEARCH AND GRAPHS
3-8
ANALYSIS
DISCUSSION OF RESULTS
8-9
RECCOMENDATION
RECCOMENDATION FOR MERCER’S HOSPITAL
9
REFERENCES
MLA CITATIONS
10-11
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Effective Tuberculosis Treatment
I N TRODUC TION |
Tuberculosis (TB), also known as consumption is a disease caused by a
bacterium called Mycobacterium tuberculosis. “The bacteria usually attack the
lungs, but it can infect and attack any part of the body such as the kidney, spine,
and brain” (Treatment). There are two kinds of Tuberculosis, Latent TB Infection
(LTBI) and TB disease. Both are treatable and non fatal if treated properly.
Currently the “treatments for Latent TB Infection are regimens of Isoniazid (INH),
Isoniazid (INH) and Rifapentine (RPT), or Rifampin (RPT)” (NHI). “Treatment for
TB disease are regimens of Isoniazid (INH), Rifampin (RIF), Ethambutol (EMB), or
Pyrazinamide (PZA)” (NHI). TB disease was once the leading cause of death in the
United States; however, it still prevalent in many third world countries such as
many of the countries in Africa. It is very expensive to be treated for this disease
because a regimen of drugs can last anywhere from 3 to 9 months. Therefore it is
important to find the most effective way and most cost effective way to treat this
disease so that everyone infected can be treated is able to afford it.
A B S T R AC T |
The Who Organization has asked for the most cost effective and effective
way to treat Latent and TB disease. Through a process of evaluating other
researches. It was found that Rifampin was the most effective and cost effective
drug in the long run for both latent and TB disease. For drug-resistant and multidrug resistant disease it was inconclusive on what the most cost effective and
effective drug regimen would be due to the fact that infected patients’ needs to be
evaluated on a case by case basis because not every patient will have a strain
resistant to the same drugs. The overall recommendation especially for Latent TB
and TB disease patients is to take regimen of drugs as prescribe without every
“skipping” a dose in order to decrease the chances of developing drug or multidrug resistant tuberculosis.
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METHODOLOGY|
Peer review journals as well as government-based websites were used to
begin the investigation of finding the most cost effective, as well as the most
effective drug to treat tuberculosis. Research sources were limited to 10 to 15
years ago until present. A pharmacist was also interviewed to find out more
information on TB drugs and their cost.
Research was broken into the following sections:
Step
Step
Step
Step
One: What is Tuberculosis, what are its symptoms, and how it is diagnose.
Two: How Tuberculosis is treated
Three: Common drug regimens and their cost
Four: Find how the cost of TB drugs can be lowered
Each step/section leads to the next so that when the information is presented it
makes logical sense. First, research on TB, what it is, how to diagnose, and how to
treat were found. Next, it is found that TB drugs are very expensive, ranging from
5000-$10000 a month. Which leads to finding the different types of treatment as
well which are the least expensive.
Before this methodology was developed, I had to revise my first experimental
question due to the fact that it to too broad so that made it hard to sort through
information. The revised research is to find the most effective and cost-effective
drug/ treatment for TB.
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RESULTS|
STEP ONE: RELEVENCE
Tuberculosis is a curable infectious disease and is also the “leading cause of
deaths in this area” (Dye). As it can be seen in the graph of the distribution of
Tuberculosis in 2003 (Dye), “Asia has the highest estimated incidence rate then
comes Africa” (Dye). Many of the countries with the highest incidence rate are
third world countries. The people infected with Tuberculosis in these countries
cannot afford high cost treatments for tuberculosis.
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S T E P T W O : W H AT I S T U B E RC U L O S I S , H O W I T ’ S C O N T R AC T E D,
I T S S Y M P TO M S, A N D H O W I T I S D I AG N O S E .
“Tuberculosis is caused by the Mycobacterium tuberculosis bacteria” (CDC).
This bacteria usually attacks the lungs, but can also attack other parts of the body,
like the kidney, spine, or brain (CDC).
Not everyone who is infected with tuberculosis develops symptoms. This
means that there are two types of tuberculosis, latent TB infection and TB disease.
Both are treatable “but without treatment TB can be fatal” (CDC).
Latent TB patients have the bacteria that causes TB in their body, however
because they are not active the patients do not display symptoms. Once the
bacteria do become active, then the patient will develop symptoms, and become
sick. It is therefore necessary to treat people with latent TB in order to control and
eliminate TB. TB Disease is when the bacteria is actually active in a patients body
which causes them to displays symptoms and get sick.
Tuberculosis can also be categorized into drug resistant TB where the
bacteria is resistant to one first-line TB drug, multidrug-resistant TB where the
bacteria is resistant to more than one first-line TB drug, and non multidrugresistant TB. In multidrug-resistant TB , and drug resistant TB patients’ have a
strain of the TB bacteria that does not respond to the general regimens of drugs
therefore different combinations of TB drugs are needed to treat this type of TB.
“Symtoms of TB Disease include but are not limited to:








Coughing that lasts three or more weeks
Coughing up blood
Chest pain, or pain with breathing or coughing
Unintentional weight loss
Fatigue
Fever
Night Sweats
Chills
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
Loss of Apetite” (CD)
Tuberculosis is spread through the air from person to person. It can be
diagnosed using a tuberculin skin test or with a TB blood test. These two tests only
show if a person has the TB bacteria in their body it does not tell if the person has
latent TB or TB disease. Having additional tests such as a chest x-ray or examining
a sample of sputum is needed to see if a patient has the TB disease.
S T E P T H R E E : H O W T U B E RC U L O S I S I S T R E AT E D & C O M M O N
D RU G R E GI M ENS AND T H E I R C OS T
Tuberculosis is treated through taking regimens of drug anywhere from 3 to 9
months. There are currently four approved regimens of drug to treat latent TB
they are:
Drugs
Duration
Interval
Minimum Doses
Isoniazid
9 Mo
Daily
270
Twice Weekly
76
Daily
180
Twice Weekly
52
Isoniazid
6 Mo
Isoniazid &
Rifapentine
3 Mo
Once Weekly
12
Rifampin
4 Mo
Daily
120
Because of liver toxicity it is not generally recommended that latent TB patients
take rifampin and pyrazinamide for treatment (CDC.gov)
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Figure 1-1
There are ten drugs approved by the US FDA to treat TB disease. The first line
drugs are Isoniazid, Rifampin, Ethambutol, and Pyrazinamide shown in Figure 1-1.
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The
Figure 1-2
Figure 1-2 gives a brief summary of what the difference between treatment for
latent tuberculosis versus multidrug-resistant tuberculosis.
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S T E P FO U R : HOW T H E CO S T O F TB D RU GS C AN B E LOW E RE D
A research done by David P. Holland and colleagues compared different regimens
of drugs for latent TB in order to find the most effective and cost-effect Latent TB
drug regimen. Their results are shown below. All four regimens were found to be
effective at treating latent TB and had the same quality of life for patients.
Graphs made using data from NHI (Holland)
A N A LY S I S |
It can be seen that normal/common tuberculosis treatment for both latent
and multidrug-resistant tuberculosis is very long. Many patients do not complete
the treatment because of how long it is, or they may skip taking the medicine
because they do not think it will make a difference but it does. Skipping
medication can be detrimental to the patient. The amount of drugs and time that it
takes to treat TB is very long therefore costing patients a lot of money to treat TB.
It is then necessary to find a drug regimen that is effective, cost-effective and
works within a time frame that most patients will actually follow and complete
their drug regimen treatment, which ensures that they are cured. From step five in
the results it can be seen that for latent TB a research trial by David P. Hollands
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and colleagues found that 4 months of rifampin is the most cost effective for
patients, it is also a very effective treatment at treating TB and compared with
other regimens still gives the same quality of life. As shown in figure 2-3 Rifampin
4 month regimen for the average lifetime cost is $495.21 compare to the usual
regimen of 9 months Isoniazid which is $679.52. Rifampin is only taken four
months versus nine months of Isoniazid more patients will complete their regimen
and be cured.
Multidrug-resistant TB is complicated because it is different case by case.
Not patient is going to be resistant to the same drugs, and they may not even
react to the second line drugs. Therefore it is very hard to find a way to lower cost
for patients who have multidrug-resistant TB.
R E C O M M E N DA T I O N |
The recommendation for Latent Tuberculosis is four months of Rifampin because it
is shown to the most cost-effective, it is also effective at treating tuberculosis, and
also gives the same quality of life. For TB disease Isoniazid or Rifampin is
recommended because they are the most potent of the first-line drugs, therefore
the most effective. Rifampin is also shown to be the most cost-effective out of the
two. There are currently no recommendation for multidrug-resistant TB because it
is a case by case. But it is recommended that physicians strongly advised patient
who do not have multidrug TB to take their medications every day it is prescribe in
order to avoid developing multidrug-resistant TB.
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REFERENCE|
Corbett, Elizabeth L. "The Growing Burden of Tuberculosis Global Trends and
Interactions With the HIV Epidemic." Access to University Library
Resources | The University of New Mexico. Arch Intern Med., 2003. Web.
8 Mar. 2016.
Doucleff, Michaeleen. "What It Takes To Cure Drug-Resistant Tuberculosis."
NPR. NPR, 9 July 2013. Web. 20 Mar. 2016.
Dye, Christopher. "Global Epidemiology of Tuberculosis." The Lancet 367.9514
(2006): 938-40. Science Direct. Web. 6 Mar. 2016.
Frieden, Thomas R. "Tuberculosis." Science Direct. The Lancet, 13 Sept. 2003.
Web. 11 Mar. 2016.
Holland, David P., Gillian D. Sanders, Carol D. Hamilton, and Jason E. Stout.
"Costs and Cost-effectiveness of Four Treatment Regimens for Latent
Tuberculosis Infection." American Journal of Respiratory and Critical Care
Medicine. American Thoracic Society, 19 Mar. 2009. Web. 25 Mar. 2016.
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Kana's, Annabel. "Treatment of Drug Resistant TB | Drugs, Costs, Rates of
Cure." TB Factsorg. GHE, n.d. Web. 27 Mar. 2016.
Suarez, Pedro G. "Feasibility and Cost-effectiveness of Standardised Second
line Drug Treatment for Chronic Tuberculosis Patients: A National Cohort
Study in Peru." The Lancet. Elsevier Inc., 8 June 2002. Web. 6 Mar. 2016.
"Treatment." Centers for Disease Control and Prevention. Centers for Disease
Control and Prevention, 09 Dec. 2011. Web. 7 Mar. 2016.
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