Gamma interferon in patients with drug-resistant pulmonary tuberculosis: clinical and cost-effectiveness aspects

Objective: To evaluate the efficacy of gamma interferon (IFN-γ) injections for patients with multidrug-resistant tuberculosis (MDR-TB) undergoing antituberculosis chemotherapy according to current clinical guidelines through a clinical and economic analysis.
Material and methods. A clinical-economic model of the two strategies for managing MDR-TB patients was developed. The costeffectiveness of these strategies was determined taking into account only the direct costs of inpatient care. Time-based costs for patient management were calculated, focusing on the period from the start of therapy to the end of the study drug administration (3 months). This included: Period 0 – the start of therapy, days 1–14 plus 3 days for testing to confirm the absence of bacterial excretion; Period 1 – days 18–30 + 3 days for testing; Period 2 – days 34–60 + 3 days for testing; Period 3 – days 64–90 + 3 days for testing. For budget impact analysis we used the difference in costs between the two treatment strategies: antituberculosis chemotherapy with IFN-γ injections (the main group) and antituberculosis chemotherapy without IFN-γ (the control group). Efficiency parameters included sputum conversion rates based on microscopy and the median time to clinical response. Cost-effectiveness ratios were calculated using the clinical efficiency of the compared therapies, taking into account sputum smear conversion rates based on microscopy. The results were verified using a one-factor sensitivity analysis based on the cost-effectiveness ratio within a range of ±30%.
Results. Pharmacotherapy costs during the first 14 days of hospitalization were higher in the group treated with IFN-γ (12,347,287.00 rubles) compared with the control group (10,723,532.00 rubles). Due to the clinical response achieved, a significantly larger number of patients in the main group are transferred to outpatient care, and costs in Period 1 for this group tend to decrease (1,394,517.12 rubles), while in the control group they are three times higher (4,138,021.76 rubles). Costs in the control group were 3.8 times higher than in the main group in Period 2, and 3.3 times higher in Period 3. Total costs for inpatient care over the 3-month treatment period with the study drug (the main group) were 1.5 times lower than those in the control group. Furthermore, the results were supported by calculations using the time to clinical response, as determined by microscopic examination. These calculations showed that the treatment in the main group was 25.64% more cost-effective than in the control group. The lower cost-effectiveness ratio in the main group compared to the control group (1,401.51 and 1,802.27, respectively) and the higher clinical efficacy in terms of the main criterion indicate that including IFN-γ in the treatment of MDR-TB patients is more cost-effective and preferable. A one-factor sensitivity analysis based on the cost-effectiveness metric confirmed the robustness of the findings to uncertainties and variations in the input data.
Conclusion. The results obtained indicate the economic feasibility of adding IFN-γ as a pathogenetic therapy for MDR-TB in combination with antituberculosis chemotherapy.

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