Health system and household costs of preventive treatment delivery for children exposed to multidrug

ABSTRACT Background Tuberculosis (TB) preventive treatment (TPT) is a core component of TB control. Levofloxacin was recently recommended by the World Health Organization as TPT in children exposed to multidrug-resistant tuberculosis (MDR-TB). However, the affordability and feasibility of TPT provision for governments, health services, individual households and global donors is uncertain. Methods TB-CHAMP was a cluster-randomized, double-blind, placebo-controlled trial investigating levofloxacin TPT in children exposed to MDR-TB in South Africa and included cost analysis of TPT delivery. We mo

delled the societal (health system and household) cost of levofloxacin TPT, other potential future (but not currently recommended) MDR-TB exposure TPT options, and compared with drug-susceptible TPT options in children and adolescents under 15 years old. We modelled costs across 12 different medicine and formulation options for 11 paediatric dosing weight-bands using TB-CHAMP and household survey data, with national and international procurement medicine pricing. Results Total societal costs of providing levofloxacin TPT and its monitoring per child were US$252 (0-<5-years) and US$256 (5-&l

t;15-years) and had comparable costs to drug-susceptible TPT regimens when using Global Drug Facility pricing. Pharmaceutical costs for a course of TPT using paediatric formulations in children <5 years varied between US$38 (levofloxacin), US$80 (bedaquiline) and US$582 (delamanid). Household costs associated with accessing TPT and ongoing monitoring ranged from 1.6%-2.1% of median annual income of affected households, with shorter TPT courses incurring lower household costs. Global Drug Facility procurement achieved TPT pricing at 70% of the costs of national South African procurement, and