Abstract
BackgroundRegimens 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.MethodsWe 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-infected patients in India. Model input parameters included a median CD4 count of 324 cells/mm3, and a rate ratio of developing TB of 0.35 for 6EH and 0.22 for 36H at three years as compared to no IPT. Results of 6EH and 36H were also compared to six months of isoniazid (6H), three months of isoniazid plus rifampin (3RH) and three months of isoniazid plus rifapentine (3RPTH).ResultsProjected TB incidence decreased in the 6EH and 36H regimens by 51% and 62% respectively at three-year follow-up compared to no IPT. Without IPT, projected life expectancy was 136.1 months at a lifetime per person cost of $5,630. 6EH increased life expectancy by 0.8 months at an additional per person cost of $100 (incremental cost-effectiveness ratio (ICER) of $1,490/year of life saved (YLS)). 36H further increased life expectancy by 0.2 months with an additional per person cost of $55 (ICER of $3,120/YLS). The projected clinical impact of 6EH was comparable to 6H and 3RH; however when compared to these other options, 6EH was no longer cost-effective given the high cost of ethambutol. Results were sensitive to baseline CD4 count and adherence.ConclusionsThree, six and thirty-six-month regimens of isoniazid-based therapy are effective in preventing TB. Three months of isoniazid plus rifampin and six-months of isoniazid are similarly cost-effective in India, and should be considered part of HIV care.
Highlights
The HIV and tuberculosis epidemics represent a major public health challenge in India [1,2]
Given the challenge of controlling these epidemics, major stakeholders convened at the World Health Organization and identified intensified TB case-finding, infection control, and isoniazid-based preventive therapy (IPT) as crucial measures in reducing the impact of TB on people living with HIV [6]
Model outcomes included the incidence of active TB and cost per person at three and ten years (2009 USD), projected life expectancy, lifetime per person costs and costeffectiveness measured in incremental cost per year of life saved (YLS)
Summary
The HIV and tuberculosis epidemics represent a major public health challenge in India [1,2]. Among the estimated 2.4 million people living with HIV/AIDS in India, the incidence of active TB has been reported as high as 6.90 cases/100 person-years (PY) [3,4]. This is driven in part by reactivation disease in the estimated 40% of HIV-infected persons latently infected with TB [5]. Given the challenge of controlling these epidemics, major stakeholders convened at the World Health Organization and identified intensified TB case-finding, infection control, and isoniazid-based preventive therapy (IPT) as crucial measures in reducing the impact of TB on people living with HIV [6]. The cost-effectiveness of IPT has not been studied in India
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
