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Cost-effectiveness of Preventive Therapy for Tuberculosis With Isoniazid and Rifapentine Versus Isoniazid Alone in High-Burden Settings.
Clin Infect Dis. 2018 09 14; 67(7):1072-1078.CI

Abstract

Background

A short-course regimen of 3 months of weekly rifapentine and isoniazid (3HP) has recently been recommended by the World Health Organization as an alternative to at least 6 months of daily isoniazid (isoniazid preventive therapy [IPT]) for prevention of tuberculosis (TB). The contexts in which 3HP may be cost-effective compared to IPT among people living with human immunodeficiency virus are unknown.

Methods

We used a Markov state transition model to estimate the incremental cost-effectiveness of 3HP relative to IPT in high-burden settings, using a cohort of 1000 patients in a Ugandan HIV clinic as an emblematic scenario. Cost-effectiveness was expressed as 2017 US dollars per disability-adjusted life year (DALY) averted from a healthcare perspective over a 20-year time horizon. We explored the conditions under which 3HP would be considered cost-effective relative to IPT.

Results

Per 1000 individuals on antiretroviral therapy in the reference scenario, treatment with 3HP rather than IPT was estimated to avert 9 cases of TB and 1 death, costing $9402 per DALY averted relative to IPT. Cost-effectiveness depended strongly on the price of rifapentine, completion of 3HP, and prevalence of latent TB. At a willingness to pay of $1000 per DALY averted, 3HP is likely to be cost-effective relative to IPT only if the price of rifapentine can be greatly reduced (to approximately $20 per course) and high treatment completion (85%) can be achieved.

Conclusions

3HP may be a cost-effective alternative to IPT in high-burden settings, but cost-effectiveness depends on the price of rifapentine, achievable completion rates, and local willingness to pay.

Authors+Show Affiliations

Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland.Aurum Health, Johannesburg, South Africa.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29617965

Citation

Johnson, Karl T., et al. "Cost-effectiveness of Preventive Therapy for Tuberculosis With Isoniazid and Rifapentine Versus Isoniazid Alone in High-Burden Settings." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 67, no. 7, 2018, pp. 1072-1078.
Johnson KT, Churchyard GJ, Sohn H, et al. Cost-effectiveness of Preventive Therapy for Tuberculosis With Isoniazid and Rifapentine Versus Isoniazid Alone in High-Burden Settings. Clin Infect Dis. 2018;67(7):1072-1078.
Johnson, K. T., Churchyard, G. J., Sohn, H., & Dowdy, D. W. (2018). Cost-effectiveness of Preventive Therapy for Tuberculosis With Isoniazid and Rifapentine Versus Isoniazid Alone in High-Burden Settings. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 67(7), 1072-1078. https://doi.org/10.1093/cid/ciy230
Johnson KT, et al. Cost-effectiveness of Preventive Therapy for Tuberculosis With Isoniazid and Rifapentine Versus Isoniazid Alone in High-Burden Settings. Clin Infect Dis. 2018 09 14;67(7):1072-1078. PubMed PMID: 29617965.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of Preventive Therapy for Tuberculosis With Isoniazid and Rifapentine Versus Isoniazid Alone in High-Burden Settings. AU - Johnson,Karl T, AU - Churchyard,Gavin J, AU - Sohn,Hojoon, AU - Dowdy,David W, PY - 2017/10/27/received PY - 2018/03/27/accepted PY - 2018/4/5/pubmed PY - 2019/10/31/medline PY - 2018/4/5/entrez SP - 1072 EP - 1078 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 67 IS - 7 N2 - Background: A short-course regimen of 3 months of weekly rifapentine and isoniazid (3HP) has recently been recommended by the World Health Organization as an alternative to at least 6 months of daily isoniazid (isoniazid preventive therapy [IPT]) for prevention of tuberculosis (TB). The contexts in which 3HP may be cost-effective compared to IPT among people living with human immunodeficiency virus are unknown. Methods: We used a Markov state transition model to estimate the incremental cost-effectiveness of 3HP relative to IPT in high-burden settings, using a cohort of 1000 patients in a Ugandan HIV clinic as an emblematic scenario. Cost-effectiveness was expressed as 2017 US dollars per disability-adjusted life year (DALY) averted from a healthcare perspective over a 20-year time horizon. We explored the conditions under which 3HP would be considered cost-effective relative to IPT. Results: Per 1000 individuals on antiretroviral therapy in the reference scenario, treatment with 3HP rather than IPT was estimated to avert 9 cases of TB and 1 death, costing $9402 per DALY averted relative to IPT. Cost-effectiveness depended strongly on the price of rifapentine, completion of 3HP, and prevalence of latent TB. At a willingness to pay of $1000 per DALY averted, 3HP is likely to be cost-effective relative to IPT only if the price of rifapentine can be greatly reduced (to approximately $20 per course) and high treatment completion (85%) can be achieved. Conclusions: 3HP may be a cost-effective alternative to IPT in high-burden settings, but cost-effectiveness depends on the price of rifapentine, achievable completion rates, and local willingness to pay. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/29617965/Cost_effectiveness_of_Preventive_Therapy_for_Tuberculosis_With_Isoniazid_and_Rifapentine_Versus_Isoniazid_Alone_in_High_Burden_Settings_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciy230 DB - PRIME DP - Unbound Medicine ER -