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The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis

There is increasing interest in future, highly-potent ‘pan-TB’ regimens against tuberculosis (TB), that may be equally effective in both drug-susceptible and rifampicin-resistant (RR) forms of TB. Taking the example of India, the country with the world’s largest burden of TB, we show that adoption o...

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Autores principales: Arinaminpathy, Nimalan, Gomez, Gabriela B., Sachdeva, Kuldeep S., Rao, Raghuram, Parmar, Malik, Nair, Sreenivas A., Rade, Kiran, Kumta, Sameer, Hermann, David, Hanson, Christy, Chin, Daniel P., Dewan, Puneet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100958/
https://www.ncbi.nlm.nih.gov/pubmed/32218585
http://dx.doi.org/10.1371/journal.pone.0230808
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author Arinaminpathy, Nimalan
Gomez, Gabriela B.
Sachdeva, Kuldeep S.
Rao, Raghuram
Parmar, Malik
Nair, Sreenivas A.
Rade, Kiran
Kumta, Sameer
Hermann, David
Hanson, Christy
Chin, Daniel P.
Dewan, Puneet
author_facet Arinaminpathy, Nimalan
Gomez, Gabriela B.
Sachdeva, Kuldeep S.
Rao, Raghuram
Parmar, Malik
Nair, Sreenivas A.
Rade, Kiran
Kumta, Sameer
Hermann, David
Hanson, Christy
Chin, Daniel P.
Dewan, Puneet
author_sort Arinaminpathy, Nimalan
collection PubMed
description There is increasing interest in future, highly-potent ‘pan-TB’ regimens against tuberculosis (TB), that may be equally effective in both drug-susceptible and rifampicin-resistant (RR) forms of TB. Taking the example of India, the country with the world’s largest burden of TB, we show that adoption of these regimens could be: (i) epidemiologically impactful, and (ii) cost-saving to the national TB programme, even if the regimen itself is more costly than current TB treatment. Mathematical modelling suggests that deployment of a pan-TB regimen in 2022 would reduce the annual incidence of TB in 2030 by 23.9% [95% Bayesian credible intervals [CrI] 17.6–30.8%] if used to treat all TB cases, and by 2.30% [95% CrI 1.57–3.48%] if used to treat only RR-TB. Notably, with a regimen costing less than USD 359 (95% CrI 287–441), treating all diagnosed TB cases with the pan-TB regimen yielded greater cost-savings than treating just those diagnosed with RR-TB. One limitation of our approach is that it does not capture the risk of resistance to the new regimen. We discuss ways in which this risk could be mitigated using modern adherence support mechanisms, as well as drug sensitivity testing at the point of TB diagnosis, to prevent new resistant forms from becoming established. A combination of such approaches would be important for maximising the useful lifetime of any future regimen.
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spelling pubmed-71009582020-04-03 The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis Arinaminpathy, Nimalan Gomez, Gabriela B. Sachdeva, Kuldeep S. Rao, Raghuram Parmar, Malik Nair, Sreenivas A. Rade, Kiran Kumta, Sameer Hermann, David Hanson, Christy Chin, Daniel P. Dewan, Puneet PLoS One Research Article There is increasing interest in future, highly-potent ‘pan-TB’ regimens against tuberculosis (TB), that may be equally effective in both drug-susceptible and rifampicin-resistant (RR) forms of TB. Taking the example of India, the country with the world’s largest burden of TB, we show that adoption of these regimens could be: (i) epidemiologically impactful, and (ii) cost-saving to the national TB programme, even if the regimen itself is more costly than current TB treatment. Mathematical modelling suggests that deployment of a pan-TB regimen in 2022 would reduce the annual incidence of TB in 2030 by 23.9% [95% Bayesian credible intervals [CrI] 17.6–30.8%] if used to treat all TB cases, and by 2.30% [95% CrI 1.57–3.48%] if used to treat only RR-TB. Notably, with a regimen costing less than USD 359 (95% CrI 287–441), treating all diagnosed TB cases with the pan-TB regimen yielded greater cost-savings than treating just those diagnosed with RR-TB. One limitation of our approach is that it does not capture the risk of resistance to the new regimen. We discuss ways in which this risk could be mitigated using modern adherence support mechanisms, as well as drug sensitivity testing at the point of TB diagnosis, to prevent new resistant forms from becoming established. A combination of such approaches would be important for maximising the useful lifetime of any future regimen. Public Library of Science 2020-03-27 /pmc/articles/PMC7100958/ /pubmed/32218585 http://dx.doi.org/10.1371/journal.pone.0230808 Text en © 2020 Arinaminpathy et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Arinaminpathy, Nimalan
Gomez, Gabriela B.
Sachdeva, Kuldeep S.
Rao, Raghuram
Parmar, Malik
Nair, Sreenivas A.
Rade, Kiran
Kumta, Sameer
Hermann, David
Hanson, Christy
Chin, Daniel P.
Dewan, Puneet
The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis
title The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis
title_full The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis
title_fullStr The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis
title_full_unstemmed The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis
title_short The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis
title_sort potential deployment of a pan-tuberculosis drug regimen in india: a modelling analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100958/
https://www.ncbi.nlm.nih.gov/pubmed/32218585
http://dx.doi.org/10.1371/journal.pone.0230808
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