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
© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:23 |
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| Enthalten in: |
Journal of the International AIDS Society - 23(2020), 10 vom: 09. Okt., Seite e25623 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ferguson, Olivia [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 08.04.2021 Date Revised 29.03.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1002/jia2.25623 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM316429422 |
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| 100 | 1 | |a Ferguson, Olivia |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a 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 |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 08.04.2021 | ||
| 500 | |a Date Revised 29.03.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a cost-effectiveness analysis | |
| 650 | 4 | |a isoniazid | |
| 650 | 4 | |a preventive therapy | |
| 650 | 4 | |a rifapentine | |
| 650 | 4 | |a short-course treatment | |
| 650 | 4 | |a tuberculosis | |
| 650 | 7 | |a Anti-HIV Agents |2 NLM | |
| 650 | 7 | |a Antitubercular Agents |2 NLM | |
| 650 | 7 | |a Isoniazid |2 NLM | |
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| 650 | 7 | |a Rifampin |2 NLM | |
| 650 | 7 | |a VJT6J7R4TR |2 NLM | |
| 650 | 7 | |a rifapentine |2 NLM | |
| 650 | 7 | |a XJM390A33U |2 NLM | |
| 700 | 1 | |a Jo, Youngji |e verfasserin |4 aut | |
| 700 | 1 | |a Pennington, Jeff |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson, Karl |e verfasserin |4 aut | |
| 700 | 1 | |a Chaisson, Richard E |e verfasserin |4 aut | |
| 700 | 1 | |a Churchyard, Gavin |e verfasserin |4 aut | |
| 700 | 1 | |a Dowdy, David |e verfasserin |4 aut | |
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