研究目的：治療潛伏結核病(Latent Tuberculosis Infection, LTBI)是消滅肺結核的基石之一。潛伏結核感染個案的服藥遵從性對於完成潛伏結核感染治療具有很大的影響力。台灣的傳統LTBI治療方法是以九個月(每天服用300 mg Isoniazid)的療程為主，並由都治關懷人員每天送藥給個案(星期一至星期五)。然而，因為治療時間冗長以及服藥所產生的相關副作用，導致能順利完成九月個療程的個案相對不多。美國已經開始使用短期十二週複方療法(3HP)，處方是以高劑量的Isoniazid與Rifapentine綜合而成，個案每個禮拜只需要服用一次，一共服用十二次即可完成LTBI治療。由於3HP的短期療法可提高潛伏結核感染的治療完成率，因此此前瞻性的研究，主要在探討短期12週療法對台灣潛伏結核病感染治療的安全性，完成率及經濟效益之影響。 研究方法及資料：本研究收集總計691位潛伏結核感染個案，包含590位服用傳統九個月療法以及101位服用複方3HP療法個案。九個月的傳統療法與3HP療法所產生的醫療費用計算方法包含藥品與都治關懷車隊人力費用。經濟效益分析則是以兩種處方分別可以避免產生一位結核病個案所產生的費用來比較。 研究結果：調查九個月傳統療法與短期3HP潛伏結核感染療法之結果顯示短期3HP療法的個案因為相關副作用而停藥的比例比九個月療法低之外，3HP的治療完成率(97.03%)明顯高出傳統九個月療法(87.29%)(p<0.001)。比較兩組的醫療成本費用方面顯示，短期12週療法需花費$261.24美元，而傳統九月個療法則需花費$717.3美元。經濟效益顯示，短期12週療法只需花費$5225美元即可避免一位潛伏結核感染個案進展成為結核病個案，傳統九個月的療法則需花費$ 15392美元才能避免一位潛伏結核感染個案進展成為結核病個案。 結論與建議：這是台灣第一篇以九個月傳統療法與短期12週潛伏結核感染來比較治療安全性及完成率與經濟效益的研究，結果顯示使用短期12週的複方療法，不但降低個案因為副作用而停止服藥的機率，更增加潛伏結核病的治療完成率。經濟效益上顯示，短期12週療法不但醫療成本花費較低，可以預防一位結核病個案產生的費用也比傳統療法來的低，期間因為就醫而產生的經濟效益更是遠超過9個月這一組。 SETTING: 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 alternative treatment option for LTBI in 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. OBJECTIVES: To assess the treatment completion rate and costs of 3HP and compare to those with 9H. METHODS: 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. RESULTS: In this study, the treatment completion rate for patients prescribed with the three 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 one case of tuberculosis and US$ 5225/avoided one case of tuberculosis with 3HP. In addition, when compared with the conventional regimen, there were less patients discontinued with rifapentine/isoniazid regimen due to undesirable side effects. CONCLUSIONS: 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.
