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Free Content Cost-effectiveness of directly observed chemoprophylaxis of tuberculosis among drug users at high risk for tuberculosis

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SETTING: A methadone treatment program with on-site medical care in the Bronx, New York.

OBJECTIVE: To define whether costs associated with directly observed preventive therapy (DOPT) of tuberculosis are justified by cases and costs of tuberculosis prevented among persons at high risk for active disease.

DESIGN: Detailed data were collected on drug users in treatment regarding human immunodeficiency virus (HIV) and tuberculosis infection and disease, and costs of screening, chemoprophylaxis, direct observation and treatment of active disease. The cost-effectiveness of providing DOPT to this population was modeled.

RESULTS: We assessed the impact of providing DOPT to 151 eligible persons. Assuming 65% isoniazid effectiveness, and incorporating costs of screening, observed chemoprophylaxis and clinical monitoring, a net savings in tuberculosis-related hospital costs of $285284 ($563 per person screened) was associated with DOPT ($10274 per case prevented). Direct observation of chemoprophylaxis proved cost-effective if associated with even a 10% increment in overall isoniazid effectiveness compared with self-administered chemoprophylaxis. DOPT costs per tuberculosis case averted remained below the in-patient costs of a single case of drug-sensitive disease across a range of parameter values.

CONCLUSIONS: Providing DOPT is a highly cost-effective intervention for drug users in treatment. Commitment of additional resources required for DOPT should be given priority in this and other populations at high risk for tuberculosis.
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Keywords: HIV infection; cost-effectiveness; drug users; prevention; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA 2: Department of Family Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA 3: Department of Epidemiology and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA

Publication date: 01 July 1998

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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