Impacts of 12-dose regimen for latent tuberculosis infection: Treatment completion rate and cost-effectiveness in Taiwan.

Treatment of latent tuberculosis infection (LTBI) is essential for eradicating tuberculosis (TB). Moreover, the patient adherence is crucial in determining the effectiveness of TB control. Isoniazid given by DOTS daily for 9 months (9H) is the standard treatment for LTBI in Taiwan. However, the completion rate is low due to the long treatment period and its side effects. The combined regimen using a high dose of rifapentine/isoniazid once weekly for 12 weeks (3HP) has been used as an alternative treatment option for LTBI in the United States. This may result in a higher completion rate. In this pilot study, patient adherence and cost of these 2 treatment regimens were investigated. Thus, we aimed to assess the treatment completion rate and costs of 3HP and compare to those with 9H.Data from 691 cases of LTBI treatments including 590 cases using the conventional regimen and 101 cases with rifapentine/Isoniazid were collected. The cost was the sum of the cost of treatment with Isoniazid for 9 months or with rifapentin/Isoniazid for 3 months of all contacts. The effectiveness was the cost of cases of tuberculosis avoided.In this study, the treatment completion rate for patients prescribed with the 3 months rifapentine/isoniazid regimen (97.03%) was higher than those given the conventional 9-month isoniazid regimen (87.29%) (P <0.001). The cost of 3HP and 9H was US$261.24 and US$717.3, respectively. The cost-effectiveness ratio with isoniazid for 9 months was US$ 15392/avoided 1 case of tuberculosis and US$ 5225/avoided 1 case of tuberculosis with 3HP. In addition, when compared with the conventional regimen, there were fewer patients discontinued with rifapentine/isoniazid regimen due to undesirable side effects.This was the first study to compare the 2 treatment regimens in Taiwan, and it showed that a short-term high-dosage rifapentine/isoniazid treatment regimen reduced costs and resulted in higher treatment completion than the standard LTBI isoniazid treatment.

A randomized study of gemcitabine plus cisplatin and vinorelbine plus cisplatin in patients with advanced non-small-cell lung cancer.

BACKGROUND: Gemcitabine plus cisplatin (GC) and vinorelbine plus cisplatin (VC) are active and well-tolerated regimens for the treatment of patients with advanced non-small-cell lung cancer (NSCLC). We conducted this study to compare the safety and efficacy of these regimens as front-line chemotherapy for patients with NSCLC. METHODS: Eligible patients were randomized to receive either gemcitabine (1000 mg/m2) on days 1, 8, and 15 plus cisplatin (80 mg/m2) on day 15 (arm GC), or vinorelbine (20 mg/m2) on days 1, 8, and 15 plus cisplatin (80 mg/m2) on day 15 (arm VC). Treatments were repeated every 28 days. The costs of treatment were retrieved from the Health Care Reporting System of Chang Gung Memorial Hospital at the time of final data analysis. RESULTS: Eighty-three patients (GC, n=39; VC, n=44) were enrolled in the study. Seventy-three patients were analyzed. Response rates were 38% and 31% and median survivals were 12.9 and 9.0 months for the 34 patients in the GC arm and 39 patients in the VC arm, respectively. One-year survival was 55.9% in the GC arm and 33.3% in the VC arm. There was no difference in the response rate (p=0.622), progression free survival (p=0.443) and median survival (p = 0.4197) between the two arms. Grade 3-4 toxicities were vomiting (GC: 16.3% vs. VC: 36.3%), neutropenia (GC: 14.7% vs. VC: 20%), and thrombocytopenia (GC: 8.68% vs. VC: 5%). There was a significant increase in all-grade thrombocytopenia (p=0.002) in the GC arm. The GC arm had higher total expenses than the VC arm (p=0.020). CONCLUSIONS: Both vinorelbine plus cisplatin and gemcitabine plus cisplatin yielded similar efficacies for NSCLC.