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Cost-effectiveness of one month of daily isoniazid and rifapentine versus three months of weekly isoniazid and rifapentine for prevention of tuberculosis among people receiving antiretroviral therapy in Uganda.
J Int AIDS Soc. 2020 10; 23(10):e25623.JI

Abstract

INTRODUCTION

Preventive therapy is essential for reducing tuberculosis (TB) burden among people living with HIV (PLWH) in high-burden settings. Short-course preventive therapy regimens, such as three-month weekly rifapentine and isoniazid (3HP) and one-month daily rifapentine and isoniazid (1HP), may help facilitate uptake of preventive therapy for latently infected patients, but the comparative cost-effectiveness of these regimens under different conditions is uncertain.

METHODS

We used a Markov state-transition model to estimate the incremental costs and effectiveness of 1HP versus 3HP in a simulated cohort of patients attending an HIV clinic in Uganda, as an example of a low-income, high-burden setting in which TB preventive therapy might be prescribed to PLWH. Our primary outcome was the incremental cost-effectiveness ratio, expressed as 2019 US dollars per disability-adjusted life year (DALY) averted. We estimated cost-effectiveness under different conditions of treatment completion and efficacy of 1HP versus 3HP, latent TB prevalence and rifapentine price.

RESULTS

Assuming equivalent clinical outcomes using 1HP and 3HP and a rifapentine price of $0.21 per 150 mg, 1HP would cost an additional $4.66 per patient treated. Assuming equivalent efficacy but 20% higher completion with 1HP versus 3HP, 1HP would cost $1,221 per DALY averted relative to 3HP. This could be reduced to $18 per DALY averted if 1HP had 5% greater efficacy than 3HP and the price of rifapentine were 50% lower. At a rifapentine price of $0.06 per 150 mg, 1HP would become cost-neutral relative to 3HP.

CONCLUSIONS

1HP has the potential to be cost-effective under many realistic circumstances. Cost-effectiveness depends on rifapentine price, relative completion and efficacy, prevalence of latent TB and local willingness-to-pay.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Department of Medicine, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.Aurum Institute, Parktown, South Africa. School of Public Health, University of Witwatersrand, Johannesburg, South Africa.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Department of Medicine, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33073520

Citation

Ferguson, Olivia, et al. "Cost-effectiveness of One Month of Daily Isoniazid and Rifapentine Versus Three Months of Weekly Isoniazid and Rifapentine for Prevention of Tuberculosis Among People Receiving Antiretroviral Therapy in Uganda." Journal of the International AIDS Society, vol. 23, no. 10, 2020, pp. e25623.
Ferguson O, Jo Y, Pennington J, et al. Cost-effectiveness of one month of daily isoniazid and rifapentine versus three months of weekly isoniazid and rifapentine for prevention of tuberculosis among people receiving antiretroviral therapy in Uganda. J Int AIDS Soc. 2020;23(10):e25623.
Ferguson, O., Jo, Y., Pennington, J., Johnson, K., Chaisson, R. E., Churchyard, G., & Dowdy, D. (2020). Cost-effectiveness of one month of daily isoniazid and rifapentine versus three months of weekly isoniazid and rifapentine for prevention of tuberculosis among people receiving antiretroviral therapy in Uganda. Journal of the International AIDS Society, 23(10), e25623. https://doi.org/10.1002/jia2.25623
Ferguson O, et al. Cost-effectiveness of One Month of Daily Isoniazid and Rifapentine Versus Three Months of Weekly Isoniazid and Rifapentine for Prevention of Tuberculosis Among People Receiving Antiretroviral Therapy in Uganda. J Int AIDS Soc. 2020;23(10):e25623. PubMed PMID: 33073520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of one month of daily isoniazid and rifapentine versus three months of weekly isoniazid and rifapentine for prevention of tuberculosis among people receiving antiretroviral therapy in Uganda. AU - Ferguson,Olivia, AU - Jo,Youngji, AU - Pennington,Jeff, AU - Johnson,Karl, AU - Chaisson,Richard E, AU - Churchyard,Gavin, AU - Dowdy,David, PY - 2020/02/27/received PY - 2020/08/20/revised PY - 2020/09/08/accepted PY - 2020/10/19/entrez PY - 2020/10/20/pubmed PY - 2020/10/20/medline KW - cost-effectiveness analysis KW - isoniazid KW - preventive therapy KW - rifapentine KW - short-course treatment KW - tuberculosis SP - e25623 EP - e25623 JF - Journal of the International AIDS Society JO - J Int AIDS Soc VL - 23 IS - 10 N2 - INTRODUCTION: Preventive therapy is essential for reducing tuberculosis (TB) burden among people living with HIV (PLWH) in high-burden settings. Short-course preventive therapy regimens, such as three-month weekly rifapentine and isoniazid (3HP) and one-month daily rifapentine and isoniazid (1HP), may help facilitate uptake of preventive therapy for latently infected patients, but the comparative cost-effectiveness of these regimens under different conditions is uncertain. METHODS: We used a Markov state-transition model to estimate the incremental costs and effectiveness of 1HP versus 3HP in a simulated cohort of patients attending an HIV clinic in Uganda, as an example of a low-income, high-burden setting in which TB preventive therapy might be prescribed to PLWH. Our primary outcome was the incremental cost-effectiveness ratio, expressed as 2019 US dollars per disability-adjusted life year (DALY) averted. We estimated cost-effectiveness under different conditions of treatment completion and efficacy of 1HP versus 3HP, latent TB prevalence and rifapentine price. RESULTS: Assuming equivalent clinical outcomes using 1HP and 3HP and a rifapentine price of $0.21 per 150 mg, 1HP would cost an additional $4.66 per patient treated. Assuming equivalent efficacy but 20% higher completion with 1HP versus 3HP, 1HP would cost $1,221 per DALY averted relative to 3HP. This could be reduced to $18 per DALY averted if 1HP had 5% greater efficacy than 3HP and the price of rifapentine were 50% lower. At a rifapentine price of $0.06 per 150 mg, 1HP would become cost-neutral relative to 3HP. CONCLUSIONS: 1HP has the potential to be cost-effective under many realistic circumstances. Cost-effectiveness depends on rifapentine price, relative completion and efficacy, prevalence of latent TB and local willingness-to-pay. SN - 1758-2652 UR - https://www.unboundmedicine.com/medline/citation/33073520/Cost_effectiveness_of_one_month_of_daily_isoniazid_and_rifapentine_versus_three_months_of_weekly_isoniazid_and_rifapentine_for_prevention_of_tuberculosis_among_people_receiving_antiretroviral_therapy_in_Uganda_ L2 - https://doi.org/10.1002/jia2.25623 DB - PRIME DP - Unbound Medicine ER -