Uso combinado de isoniazida e rifapentina no tratamento da tuberculose latente: um estudo de impacto orçamentário

Abstract

Tuberculosis is a serious public health problem and is configured as a major disease to be faced in Brazil and worldwide. To contain the epidemic around the world through prevention, diagnosis and treatment is estimated to need investments of around eight billion dollars annually. The disease comes in two forms: active and latent. The active form is manifested with classical symptoms such as persistent cough (with or without mucus and eventually blood), fever, night sweats and weight loss, being transmitted. In latently (LTBI), the individual shows no symptoms and no sign of the etiologic agent in sputum despite the PPD test is positive. By the need to prevent the latently evolve into the active form, in Brazil, the National Program for Tuberculosis Control recommends treatment with isoniazid daily for at least six months. However, this alone has brought concerns due to isoniazid-induced hepatitis and impaired adherence to treatment due to prolonged use of the drug. Alternatively, the combination of isoniazid and rifapentine in weekly doses for three months, has been the most studied pharmacotherapeutic scheme today. Equivalent effectiveness to treatment with isoniazid, the best results in terms of adhesion and therefore higher chances of therapeutic success due to the shorter period of therapy that patients undergo. The objective of this study was to estimate the budget impact of the combined use of isoniazid and rifapentine in the treatment of individuals affected by latent TB, in view of the Pharmaceutical Care General Coordination and Strategic Medicines of the Ministry of Health of Brazil, the time horizon of 2016 – 2020. To estimate the budget impact were outlined scenarios based on state and national epidemiological data of active TB, latent TB and drug costs used in the treatment of disease that are acquired and distributed by the Ministry of Health of Brazil. Accordingly, the combined use of isoniazid and rifapentine would cause impacts to the budget for the purchase of drugs for treatment of tuberculosis, the General Coordination Pharmaceutical Assistance and Strategic Medicines of the order of 21.05% in 2016, 18.54% in 2017, 16.93% in 2018, 15.50% in 2019 and 14.13% in 2020. The adoption of new treatment strategy (isoniazid and rifapentine for three months), to meet 100% of projected demand in the study, would imply spending total of R$ 35.772.400,68 in the period 2016 – 2020, requiring the need for additional funds of R$ 33.631.832,08 to spending on tuberculosis Pharmaceutical assistance General Coordination and Strategic Medicines - CGAFME, for the same period.