BACKGROUND: WHO recommends isoniazid preventive therapy (IPT) for young children in close contact with an infectious tuberculosis (TB) case. No models have examined the cost effectiveness of this recommendation. METHODS: A decision analysis model was developed to estimate health and economic outcomes of five TB infection screening strategies in young household contacts. In the no-testing strategy, children received IPT based on age and reported exposure. Other strategies included testing for infection with a tuberculin skin test (TST), interferon γ release assay (IGRA) or IGRA after TST. Markov modelling included age-specific disease states and probabilities while considering risk of re-infection in a high-burden country. RESULTS: Among the 0-2-year-old cohort, the no-testing strategy was most cost effective. The discounted societal cost of care per life year saved ranged from US$237 (no-testing) to US$538 (IGRA only testing). Among the 3-5-year-old cohort, strategies employing an IGRA after a negative TST were most effective, but were associated with significant incremental cost (incremental cost-effectiveness ratio >US$233 000), depending on the rate of Mycobacterium tuberculosis infection. CONCLUSION: Screening for M tuberculosis infection and provision of IPT in young children is a highly cost-effective intervention. Screening without testing for M tuberculosis infection is the most cost-effective strategy in 0-2-year-old children and the preferred strategy in 3-5-year-old children. Lack of testing capacity should therefore not be a barrier to IPT delivery. These findings highlight the cost effectiveness of contact tracing and IPT delivery in young children exposed to TB in high-burden countries.
BACKGROUND: WHO recommends isoniazid preventive therapy (IPT) for young children in close contact with an infectious tuberculosis (TB) case. No models have examined the cost effectiveness of this recommendation. METHODS: A decision analysis model was developed to estimate health and economic outcomes of five TB infection screening strategies in young household contacts. In the no-testing strategy, children received IPT based on age and reported exposure. Other strategies included testing for infection with a tuberculin skin test (TST), interferon γ release assay (IGRA) or IGRA after TST. Markov modelling included age-specific disease states and probabilities while considering risk of re-infection in a high-burden country. RESULTS: Among the 0-2-year-old cohort, the no-testing strategy was most cost effective. The discounted societal cost of care per life year saved ranged from US$237 (no-testing) to US$538 (IGRA only testing). Among the 3-5-year-old cohort, strategies employing an IGRA after a negative TST were most effective, but were associated with significant incremental cost (incremental cost-effectiveness ratio >US$233 000), depending on the rate of Mycobacterium tuberculosis infection. CONCLUSION: Screening for M tuberculosis infection and provision of IPT in young children is a highly cost-effective intervention. Screening without testing for M tuberculosis infection is the most cost-effective strategy in 0-2-year-old children and the preferred strategy in 3-5-year-old children. Lack of testing capacity should therefore not be a barrier to IPT delivery. These findings highlight the cost effectiveness of contact tracing and IPT delivery in young children exposed to TB in high-burden countries.
Authors: Leonardo Martinez; Ye Shen; Andreas Handel; Srijita Chakraburty; Catherine M Stein; LaShaunda L Malone; W Henry Boom; Frederick D Quinn; Moses L Joloba; Christopher C Whalen; Sarah Zalwango Journal: Lancet Respir Med Date: 2017-12-19 Impact factor: 30.700
Authors: Anna M Mandalakas; H Lester Kirchner; Gerhard Walzl; Robert P Gie; H Simon Schaaf; Mark F Cotton; Harleen M S Grewal; Anneke C Hesseling Journal: Am J Respir Crit Care Med Date: 2015-04-01 Impact factor: 21.405
Authors: Gregory James Fox; Nguyen Viet Nhung; Dinh Ngoc Sy; Luu Thi Lien; Nguyen Kim Cuong; Warwick John Britton; Guy Barrington Marks Journal: PLoS One Date: 2012-11-15 Impact factor: 3.240
Authors: Nelda van Soelen; Karen du Preez; Susan S van Wyk; Anna M Mandalakas; Don A Enarson; Anthony J Reid; Anneke C Hesseling Journal: PLoS One Date: 2013-12-10 Impact factor: 3.240
Authors: Micaela Sandoval; Padma Swamy; Alexander W Kay; Pilar Ustero Alonso; Gloria Sisi Dube; Hypertia Hlophe-Dlamini; Anna M Mandalakas Journal: Am J Trop Med Hyg Date: 2020-09-24 Impact factor: 3.707