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Cost-Effectiveness of isoniazid preventive therapy among HIV-infected patients clinicaly screened for latent tuberculosis infection in Dar es Salaam, Tanzania: A prospective Cohort study

Published on Dec 1, 2018in BMC Public Health2.567
· DOI :10.1186/s12889-017-4597-9
Grace A. Shayo4
Estimated H-index: 4
(MUHAS: Muhimbili University of Health and Allied Sciences),
Dereck Chitama4
Estimated H-index: 4
(MUHAS: Muhimbili University of Health and Allied Sciences)
+ 3 AuthorsFerdinand Mugusi30
Estimated H-index: 30
(MUHAS: Muhimbili University of Health and Allied Sciences)
Abstract
Abstract Background One of the reasons why Isoniazid preventive therapy (IPT) for Tuberculosis (TB) is not widely used in low income countries is concerns on cost of excluding active TB. We analyzed the cost-effectiveness of IPT provision in Tanzania having ruled out active TB by a symptom-based screening tool. Methods Data on IPT cost-effectiveness was prospectively collected from an observational cohort study of 1283 HIV-infected patients on IPT and 1281 controls; followed up for 24 months. The time horizon for the analysis was 2 years. Number of TB cases prevented and deaths averted were used for effectiveness. A micro costing approach was used from a provider perspective. Cost was estimated on the basis of clinical records, market price or interviews with medical staff. We annualized the cost at a discount of 3%. A univariate sensitivity analysis was done. Results are presented in US at an average annual exchange rate for the year 2012 which was Tanzania shillings 1562.4 for 1 US Results The number of TB cases prevented was 420/100,000 persons receiving IPT. The number of deaths averted was 979/100,000 persons receiving IPT. Incremental cost due to IPT provision was US 170,490. The incremental cost effective ratio was US 405.93 per TB case prevented and US 174.15 per death averted. These costs were less than 3 times the 768 US Gross Domestic Product (GDP) per capita for Tanzania in the year 2014, making IPT provision after ruling out active TB by the symptom-based screening tool cost-effective. The results were robust to changes in laboratory and radiological tests but not to changes in recurrent, personnel, medication and utility costs. Conclusion IPT should be given to HIV-infected patients who screen negative to symptom-based TB screening questionnaire. Its cost-effectiveness supports government policy to integrate IPT to HIV/AIDS care and treatment in the country, given the availability of budget and the capacity of health facilities.
  • References (18)
  • Citations (2)
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References18
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#1Grace A. Shayo (MUHAS: Muhimbili University of Health and Allied Sciences)H-Index: 4
#2Candida Moshiro (MUHAS: Muhimbili University of Health and Allied Sciences)H-Index: 7
Last. Ferdinand Mugusi (MUHAS: Muhimbili University of Health and Allied Sciences)H-Index: 30
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Background Proper adherence to isoniazid preventive therapy (IPT) may depend upon the results of tuberculosis (TB) screening test and patients’ understanding of their risk of developing active TB. We conducted a study to assess the acceptability, adherence and completion profile of IPT among HIV-infected patients who were clinically screened for latent TB Infection (LTBI).
4 CitationsSource
In Botswana, a 36-month course of isoniazid treatment of latent tuberculosis (TB) infection [isoniazid preventive therapy (IPT)] was superior to 6-month IPT in reducing TB and death in persons living with HIV (PLHIV), having positive tuberculin skin tests (TSTs) but not in those with negative TST. We examined the cost-effectiveness of IPT in Botswana, where antiretroviral therapy (ART) is widely available.Using a decision-analytic model, we determined the incremental cost-effectiveness of strate...
3 CitationsSource
#2Bruce A. Larson (BU: Boston University)H-Index: 24
Last. Sydney Rosen (BU: Boston University)H-Index: 38
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Many countries use the cost–effectiveness thresholds recommended by the World Health Organization’s Choosing Interventions that are Cost–Effective project (WHO-CHOICE) when evaluating health interventions. This project sets the threshold for cost–effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country’s annual gross domestic product (GDP) per capita. Highly cost–effective interventions are defined as meeting a threshold per...
243 CitationsSource
The human immunodeficiency virus (HIV) infection and tuberculosis (TB) epidemics are major threats to global public health. About one third of the 35.3 million people living with HIV are latently infected with Mycobacterium tuberculosis, and are more likely to develop active TB disease than people who are not infected with HIV1,2 The World Health Organization (WHO) recommends the Three I’s for HIV/TB and early initiation of antiretroviral therapy (ART) to reduce the burden of TB in HIV-positive ...
7 CitationsSource
#1Grace A. Shayo (MUHAS: Muhimbili University of Health and Allied Sciences)H-Index: 4
#2Lilian T. Minja (MUHAS: Muhimbili University of Health and Allied Sciences)H-Index: 1
Last. Ferdinand Mugusi (MUHAS: Muhimbili University of Health and Allied Sciences)H-Index: 30
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Objectives We assessed the usefulness of the National TB and Leprosy Control Program (NTLP) symptom-based tuberculosis (TB) screening tool in identifying HIV-infected patients eligible for isoniazid preventive therapy in Muhimbili National Hospital, Dar es Salaam Tanzania. Methods Descriptive cross-sectional study. Data collected included socio-demographic and clinical data. Chest X-ray, sputum for acid-fast bacilli (AFB) microscopy, mycobacterial culture, CD4 + count and complete blood count we...
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#1Xiao Xu (Yale University)H-Index: 23
#2Holly K. Grossetta Nardini (Yale University)H-Index: 5
Last. Jennifer Prah (Leonard Davis Institute of Health Economics)H-Index: 27
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Micro-costing is a cost estimation method that allows for precise assessment of the economic costs of health interventions. It has been demonstrated to be particularly useful for estimating the costs of new interventions, for interventions with large variability across providers, and for estimating the true costs to the health system and to society. However, existing guidelines for economic evaluations do not provide sufficient detail of the methods and techniques to use when conducting micro-co...
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#1Deliana Kostova (CDC: Centers for Disease Control and Prevention)H-Index: 11
#2Carrie Reed (CDC: Centers for Disease Control and Prevention)H-Index: 29
Last. Joseph S. Bresee (CDC: Centers for Disease Control and Prevention)H-Index: 72
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Context: The goal of influenza vaccination programs is to reduce influenza-associated disease outcomes. Therefore, estimating the reduced burden of influenza as a result of vaccination over time and by age group would allow for a clear understanding of the value of influenza vaccines in the US, and of areas where improvements could lead to greatest benefits. Objective: To estimate the direct effect of influenza vaccination in the US in terms of averted number of cases, medicallyattended cases, a...
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#1Mai T. Pho (U of C: University of Chicago)H-Index: 6
#2Soumya SwaminathanH-Index: 53
Last. Rochelle P. WalenskyH-Index: 53
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BACKGROUND: Regimens for isoniazid-based preventive therapy (IPT) for tuberculosis (TB) in HIV-infected individuals have not been widely adopted given concerns regarding efficacy adherence and drug resistance. Further the cost-effectiveness of IPT has not been studied in India. METHODS: We used an HIV/TB model to project TB incidence life expectancy cost and incremental cost-effectiveness of six months of isoniazid plus ethambutol (6EH) thirty-six months of isoniazid (36H) and no IPT for HIV-inf...
16 CitationsSource
#1Salome CharalambousH-Index: 30
#2Alison D. Grant (Lond: University of London)H-Index: 43
Last. Gavin J. Churchyard (UKZN: University of KwaZulu-Natal)H-Index: 50
view all 8 authors...
Objective To describe the association between isoniazid preventive therapy (IPT) and mortality among individuals starting antiretroviral therapy (ART) in a workplace programme in South Africa where tuberculosis incidence is very high.
35 CitationsSource
#1Marcus A. Bachhuber (UPenn: University of Pennsylvania)H-Index: 13
#2Robert E. Gross (UPenn: University of Pennsylvania)H-Index: 64
Une meta-analyse du traitement preventif a l'isoniazide (IPT) chez les sujets seropositifs pour le virus de l'immunodeficience humaine n'a pas reussi a demontrer d'avantages en matiere de mortalite, meme si la tuberculose est la cause principale de deces dans ce groupe de patients. Les resultats chez les patients positifs pour la tuberculine purifiee (PPD) sont toutefois heterogenes, et dans deux des essais inclus, le nombre de cas a statut PPD inconnu est eleve. Lorsque l'on attribue l'ensemble...
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#1Atieh Yaghoubi (MUMS: Mashhad University of Medical Sciences)H-Index: 1
#2Sepideh Salehabadi (MUMS: Mashhad University of Medical Sciences)
Last. Saman Soleimanpour (MUMS: Mashhad University of Medical Sciences)H-Index: 7
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Abstract Background Acquired Immunodeficiency Syndrome (AIDS) and tuberculosis (TB) represent major public health problems. The aim of this systematic review and meta-analysis is the assessment of the prevalence of tuberculosis, human immunodeficiency viruses (HIV), and co-infection of both, in pregnant women. Methods We searched the literature in PubMed, Scopus, EMBASE, Web of Knowledge and MeSH, from all years of study until 25 April 2018, for articles and abstracts describing tuberculosis, HI...
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#1Yanbing Zeng (Ha Tai: Xiamen University)
#2Mingliang Luo (Ha Tai: Xiamen University)
Last. Ya Fang (Ha Tai: Xiamen University)H-Index: 1
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Abstract Objective To evaluate the economic impact of the current measles vaccination program in Zhejiang Province, east China. Methods A decision tree-Markov model with parameters from published literatures, government documents and surveys was developed and used to simulate over 40 years of a birth cohort in Zhejiang Province during the year 2014. The expected cost and effectiveness of the current measles vaccination program was compared against no vaccination. Costs were assessed from the pay...
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#1Kesetebirhan Delele Yirdaw (FHI 360)H-Index: 1
#2Alula M. TekluH-Index: 3
Last. Solomon Zewdu (BMGF: Bill & Melinda Gates Foundation)H-Index: 1
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Introduction Isoniazid preventive therapy (IPT) is a proven means to prevent tuberculosis (TB) disease among people living with HIV (PLHIV). However, there is a concern that patients often develop tuberculosis disease while receiving IPT, defined here as breakthrough tuberculosis, which may affect treatment outcome. In this study, we assessed the magnitude and determinants of breakthrough tuberculosis. Methods A multisite retrospective longitudinal study from the year 2005 to 2014 involving 11 r...
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