Review Article
Volume 3 Issue 7 - 2021
Cost-Minimization and Budgetary Impact of the Use of Cycloserine in the Treatment of Resistant Tuberculosis
Alessandra Santos Portela1*, Andrea dos Santos Garcia1, Daniel Aragão Machado2, Antônio Augusto de Freitas Peregrino3, Cristiano Bertolossi Marta4, Carlos Roberto Lyra da Silva3 and Roberto Carlos Lyra da Silva3
1Doctoral Student in the Postgraduate Program in Nursing and Biosciences, Academic Nursing Unit, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
2Doctor of the Graduate Program in Technology in the Hospital Space, Academic Nursing Unit, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
3Doctor of the Graduate Program in Nursing and Biosciences, Academic Nursing Unit, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
4Doctor at the School of Nursing, Academic Nursing Unit, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
*Corresponding Author:Alessandra Santos Portela, Doctoral Student in the Postgraduate Program in Nursing and Biosciences, Academic Nursing Unit, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
Received: September 17, 2020; Published: June 28, 2021




Abstract

Objective: To carry out a cost-minimization and budgetary impact assessment for the incorporation of cycloserine as a second-line drug in the treatment scheme for multidrug-resistant tuberculosis in the Brazilian Unified Health System (SUS).

Methods: The analysis of cost-minimization and budgetary impact followed the recommendations of the Methodological Guideline for Economic Evaluation and the Methodological Guideline for the Assessment of Budgetary Impact. A model was proposed using a simple decision tree with a base case composed of two scenarios: the reference one, using terizidone as a second-line medication standardized by the Ministry of Health in the therapeutic regimen of patients with MDR-TB, and the alternative scenario, using cycloserine.

Results: The safety outcomes were not considered to be adverse effects. No studies were found that assessed the cure rate outcome. A single study estimated the relative risk (RR) for treatment failure or relapse outcome for longer MDR-TB regimens, suggesting that cycloserine and terizidone have the same efficacy, considering the analyzed outcomes.

Conclusion: Cycloserine can be cost-effective. It must be considered that the incremental cost of incorporating cycloserine can be R$ 2,829,825.60, with a budgetary impact that can reach more than R$ 12 million, resulting in an increase of 26% to 29% in public spending in 5 years. These resources could be applied to other measures that may represent greater benefits for these patients.

Keywords: Cycloserine; Terizidone; Tuberculosis; Cost-Benefit Analysis; Budgetary Impact Analysis

References

  1. Word Health Organization – WHO. Manual de Diagnóstico e Tratamento de Tuberculose Resistente e Multi-Droga Resistente (2020).
  2. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. (BR). Manual de Recomendações para o Controle da Tuberculose no Brasil / Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância das Doenças Transmissíveis”. 2a edition. Brasília: ANVISA (2019): 364.
  3. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Panorama da tuberculose no Brasil: a mortalidade em números [recurso eletrônico] / Ministério da Saúde, Secretaria de 2016) Vigilância em Saúde, Departamento de Vigilância das Doenças Transmissíveis. – Brasília: Ministério da Saúde (2016): 126.
  4. Migliori GB., et al. “Drug resistance beyond extensively rea-resistant tuberculosis: individual patient data meta-analysis”. European Respiratory Journal 1 (2013): 169-179.
  5. Pooran A., et al. “What is the cost of diagnosis and management of resistant tuberculosis in South Africa?” PloS One1 (2013): e54587.
  6. Hwang TJ., et al. “Safety of cycloserine and terizidone for the treatment of resistant tuberculosis: a meta-analysis”. The International Journal of Tuberculosis and Lung Disease 10 (2013): 1257-1266.
  7. Costa JG., et al. “Tuberculose em Salvador: custos para o sistema de saúde e para as famílias”. Rev. Saúde Pública, São Paulo 39.1 (2005): 122-128.
  8. Fernandez AS., et al. “Avaliação econômica nos serviços de atenção aos pacientes com tuberculose em Salvador-Bahia-Brasil 2002-2003.
  9. World Health Organization. Global tuberculosis report 2019. Geneva: World Health Organization; (2019).
  10. Arruda, Karla Gleice de. Avaliação dos custos do tratamento de tuberculose em município de médio porte do Nordeste brasileiro. Dissertação de Mestrado. Universidade Federal de Pernambuco (2014).
  11. “Ministério da Saúde. Secretaria de Vigilância em Saúde. Boletim Epidemiológico de Tuberculose (2020).
  12. Sharma SK., et al. “Rifamycins (rifampicin, rifabutin and rifapentine) compared to isoniazid for preventing tuberculosis in HIV‐negative people at risk of active TB”. The Cochrane Database of Systematic Reviews 7 (2013): CD007545.
  13. S. Food and Drug Administration (FDA). Prescribing Information of Priftin: rifapentine. Sanofi-Aventus US (2010).
Citation: Alessandra Santos Portela., et al. “Cost-Minimization and Budgetary Impact of the Use of Cycloserine in the Treatment of Resistant Tuberculosis”. EC Nursing and Healthcare 3.7 (2021): 98-108.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


December Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the December issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 17, 2021.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk