OBJECTIVE: To assess the economic benefits and costs of providing isoniazid preventive therapy for tuberculosis (TB) in HIV-infected persons in Zambia. DESIGN: A spreadsheet model incorporating variables drawn from published studies and unpublished data. SUBJECTS: Data drawn from a number of different studies and published literature involving a range of subjects. SETTING: Zambia. RESULTS: Using data primarily from Zambia we have modelled the costs and benefits of a TB preventive therapy programme using daily isoniazid for 6 months. The basecase scenario assumes recruitment at a voluntary testing and counselling site where HIV seroprevalence is 30%; persons with HIV have a 25% probability of developing active TB during their lifetime; two additional cases of TB would be prevented per person completing a course of preventive therapy; compliance would be 63%, and the efficacy of the isoniazid in preventing active TB of 60%. The costs under this scenario would exceed the benefits by a factor of 1.16 [benefit: cost ratio (BCR) of 0.86]. However, if preventing one case of TB prevented an additional five cases, the benefits would exceed the costs by a significant margin (BCR of 1.71). Other scenarios indicate that the targeted preventive therapy of persons with HIV whose occupation or living situation places them in contact with a large number of others (teachers and students, health personnel, military and police, miners, prisoners, etc.) would yield significant net benefit. The operational challenge for TB preventive therapy is thus to identify and target large numbers of such persons.
OBJECTIVE: To assess the economic benefits and costs of providing isoniazid preventive therapy for tuberculosis (TB) in HIV-infectedpersons in Zambia. DESIGN: A spreadsheet model incorporating variables drawn from published studies and unpublished data. SUBJECTS: Data drawn from a number of different studies and published literature involving a range of subjects. SETTING: Zambia. RESULTS: Using data primarily from Zambia we have modelled the costs and benefits of a TB preventive therapy programme using daily isoniazid for 6 months. The basecase scenario assumes recruitment at a voluntary testing and counselling site where HIV seroprevalence is 30%; persons with HIV have a 25% probability of developing active TB during their lifetime; two additional cases of TB would be prevented per person completing a course of preventive therapy; compliance would be 63%, and the efficacy of the isoniazid in preventing active TB of 60%. The costs under this scenario would exceed the benefits by a factor of 1.16 [benefit: cost ratio (BCR) of 0.86]. However, if preventing one case of TB prevented an additional five cases, the benefits would exceed the costs by a significant margin (BCR of 1.71). Other scenarios indicate that the targeted preventive therapy of persons with HIV whose occupation or living situation places them in contact with a large number of others (teachers and students, health personnel, military and police, miners, prisoners, etc.) would yield significant net benefit. The operational challenge for TB preventive therapy is thus to identify and target large numbers of such persons.
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Keywords:
Acquired Immunodeficiency Syndrome; Africa; Africa South Of The Sahara; Cost Benefit Analysis; Developing Countries; Diseases; Eastern Africa; English Speaking Africa; Evaluation; Hiv Infections; Infections; Quantitative Evaluation; Research Report; Treatment--cost; Tuberculosis--prevention and control; Viral Diseases; Zambia
Authors: Krishna P Reddy; Mark F Brady; Robert H Gilman; Jorge Coronel; Marcos Navincopa; Eduardo Ticona; Gonzalo Chavez; Eduardo Sánchez; Christian Rojas; Lely Solari; Jorge Valencia; Yvett Pinedo; Carlos Benites; Jon S Friedland; David A J Moore Journal: Clin Infect Dis Date: 2010-04-01 Impact factor: 9.079
Authors: R M G J Houben; D W Dowdy; A Vassall; T Cohen; M P Nicol; R M Granich; J E Shea; P Eckhoff; C Dye; M E Kimerling; R G White Journal: Int J Tuberc Lung Dis Date: 2014-05 Impact factor: 2.373
Authors: Haileyesus Getahun; Alberto Matteelli; Ibrahim Abubakar; Mohamed Abdel Aziz; Annabel Baddeley; Draurio Barreira; Saskia Den Boon; Susana Marta Borroto Gutierrez; Judith Bruchfeld; Erlina Burhan; Solange Cavalcante; Rolando Cedillos; Richard Chaisson; Cynthia Bin-Eng Chee; Lucy Chesire; Elizabeth Corbett; Masoud Dara; Justin Denholm; Gerard de Vries; Dennis Falzon; Nathan Ford; Margaret Gale-Rowe; Chris Gilpin; Enrico Girardi; Un-Yeong Go; Darshini Govindasamy; Alison D Grant; Malgorzata Grzemska; Ross Harris; C Robert Horsburgh; Asker Ismayilov; Ernesto Jaramillo; Sandra Kik; Katharina Kranzer; Christian Lienhardt; Philip LoBue; Knut Lönnroth; Guy Marks; Dick Menzies; Giovanni Battista Migliori; Davide Mosca; Ya Diul Mukadi; Alwyn Mwinga; Lisa Nelson; Nobuyuki Nishikiori; Anouk Oordt-Speets; Molebogeng Xheedha Rangaka; Andreas Reis; Lisa Rotz; Andreas Sandgren; Monica Sañé Schepisi; Holger J Schünemann; Surender Kumar Sharma; Giovanni Sotgiu; Helen R Stagg; Timothy R Sterling; Tamara Tayeb; Mukund Uplekar; Marieke J van der Werf; Wim Vandevelde; Femke van Kessel; Anna van't Hoog; Jay K Varma; Natalia Vezhnina; Constantia Voniatis; Marije Vonk Noordegraaf-Schouten; Diana Weil; Karin Weyer; Robert John Wilkinson; Takashi Yoshiyama; Jean Pierre Zellweger; Mario Raviglione Journal: Eur Respir J Date: 2015-09-24 Impact factor: 16.671