Abstract Background While effective, tuberculosis (TB) treatment is long and burdensome. Biomarker-guided strategies to shorten therapy have the potential to reduce costs and improve adherence, but the conditions under which such strategies are cost-effective remain unclear. Table 1. Key model inputs and assumptionsTable 2. Model outputs Methods We developed a Markov model to evaluate the cost-effectiveness of biomarker-guided treatment shortening in South India. Three scenarios were modeled: standard six-month therapy and biomarker-guided completion at four or two months. Outcomes included costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs). We conducted one- and two-way sensitivity analyses varying test cost and negative predictive value (NPV), and generated cost-effectiveness acceptability curves (CEACs). Two-way sensitivity analysis of test cost and negative predictive value1A) Analysis with treatment completion at two months at 571. 50 willingness to pay threshold; 1B) Analysis with treatment completion at four months at 571. 50 willingness to pay thresholdCost-effectiveness acceptability curves for biomarker testing relative to standard therapy. 2A) Serology testing at two months; 2B) lateral flow testing at two months; 2C) Serology testing at four months; 2D) lateral flow testing at four months Results At a willingness-to-pay threshold of 571. 50 per DALY averted, biomarker-guided treatment at four or two months was cost-saving compared to standard therapy for all test types except sequencing. For two-month strategies, ICERs ranged from dominance (nucleic-acid amplification test, lateral flow, and serology) to 675/DALY averted (sequencing). At four months, all non-sequencing tests dominated standard care. In one-way sensitivity analysis, results were most sensitive to test cost and NPV. Two-way analysis revealed that two-month strategies were cost-effective if NPV≥0. 77 and test cost ≤105; four-month strategies were cost-effective if NPV ≥0. 75 and test cost ≤96. CEACs showed serology and lateral flow tests had 80% probability of being cost-effective across most simulated scenarios at both time points. Conclusion Biomarker-guided treatment shortening can be highly cost-effective in high-burden settings, particularly if test costs are low and NPVs high. These findings can inform target product profiles for TB biomarkers. Disclosures All Authors: No reported disclosures
Shah et al. (Thu,) studied this question.