Health system and household costs of preventive treatment delivery for children exposed to multidrug-resistant tuberculosis in South Africa
9 affiliations
- 1Health Economics Unit, School of Public Health, University of Cape Town, Cape Town, South Africa
- 2Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
- 3Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- 4Innovative Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
- 5Wits Research Health Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- 6THINK, THINK South Africa, Durban, South Africa
- 7Perinatal HIV Research Unit (PHRU) and Infectious Diseases and Oncology Research Institute, University of Witwatersrand, Johannesburg, South Africa
- 8Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, United States of America
- 9Department of Infectious Disease, Imperial College London, London, United Kingdom
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: This costing analysis used empirical data collected alongside the TB-CHAMP clinical trial which investigated levofloxacin TPT in children exposed to MDR-TB in South Africa. We modelled 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 US252 (0− < 5 years) and US256 (5- < 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 child-friendly 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 enabled access to a wider range of child-friendly formulations. Discussion: Costs of TPT are influenced by factors including medicine pricing and procurement, the use of child-friendly formulations, implementation approach, the duration of treatment, and choice of TPT regimen across weight and age distributions. Costs to households are relatively small but may be significant for impoverished households already managing the financial disruption of a family member with MDR-TB disease.
Related
- Household contact management of drug-resistant tuberculosis: a global cost-effectiveness modelling analysis of expanded preventive treatment by age
- Treatment outcomes and post-treatment mortality among people with multidrug/rifampicin-resistant tuberculosis in Sierra Leone: a national cohort study
- Not Sick, Yet Treated: Barriers and Facilitators to Tuberculosis Preventive Treatment Uptake Among Household Contacts of Tuberculosis Patients in Moulvibazar District, Bangladesh
- Tuberculosis preventive treatment and care cascade among household contacts of patients starting tuberculosis treatment in Southern Africa: a multicountry cohort analysis
- Early sputum bacterial load dynamics predict treatment response in multidrug-resistant/rifampicin-resistant tuberculosis: A multicenter prospective cohort study
BibTeX
@article{wilkinson2026health,
title = {{Health system and household costs of preventive treatment delivery for children exposed to multidrug-resistant tuberculosis in South Africa}},
author = {Thomas Wilkinson and Suereta Fortuin and Anneke C. Hesseling and H. Simon Schaaf and Trinh Duong and Diana M. Gibb and Susan E. Purchase and Lee Fairlie and Suzanne Staples and Neil Martinson and Edina Sinanovic and James A. Seddon},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0336561},
url = {https://doi.org/10.1371/journal.pone.0336561},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Health system and household costs of preventive treatment delivery for children exposed to multidrug-resistant tuberculosis in South Africa
AU - Thomas Wilkinson
AU - Suereta Fortuin
AU - Anneke C. Hesseling
AU - H. Simon Schaaf
AU - Trinh Duong
AU - Diana M. Gibb
AU - Susan E. Purchase
AU - Lee Fairlie
AU - Suzanne Staples
AU - Neil Martinson
AU - Edina Sinanovic
AU - James A. Seddon
PY - 2026
DA - 2026/10/08
JO - PLOS One
DO - 10.1371/journal.pone.0336561
UR - https://doi.org/10.1371/journal.pone.0336561
AB - 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: This costing analysis used empirical data collected alongside the TB-CHAMP clinical trial which investigated levofloxacin TPT in children exposed to MDR-TB in South Africa. We modelled 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 US252 (0− < 5 years) and US256 (5- < 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 child-friendly 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 enabled access to a wider range of child-friendly formulations. Discussion: Costs of TPT are influenced by factors including medicine pricing and procurement, the use of child-friendly formulations, implementation approach, the duration of treatment, and choice of TPT regimen across weight and age distributions. Costs to households are relatively small but may be significant for impoverished households already managing the financial disruption of a family member with MDR-TB disease.
SN - 1932-6203
ER -