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Cost-effectiveness of tuberculosis screening and isoniazid treatment in the TB/HIV in Rio (THRio) Study
DESIGN: We used decision analysis, populated by data from a cluster-randomized trial, to project the costs (in 2010 USD) and effectiveness (in disability-adjusted life years [DALYs] averted) of training health care workers to implement the tuberculin skin test (TST), followed by IPT for TST-positive patients with no evidence of active TB. This intervention was compared to a baseline of usual care. We used time horizons of 1 year for the intervention and 20 years for disease outcomes, with all future DALYs and medical costs discounted at 3% per year.
RESULTS: Providing this intervention to 100 people would avert 1.14 discounted DALYs (1.57 undiscounted DALYs). The median estimated incremental cost-effectiveness ratio was $2273 (IQR $1779–$3135) per DALY averted, less than Brazil's 2010 per capita gross domestic product (GDP) of $11 700. Results were most sensitive to the cost of providing the training.
CONCLUSION: Training health care workers to screen HIV-infected adults with TST and provide IPT to those with latent tuberculous infection can be considered cost-effective relative to the Brazilian GDP per capita.
Keywords: Brazil; IPT; TB-HIV co-infection; economic analysis; skin tests
Document Type: Research Article
Affiliations: 1: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore 2: Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore 3: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 4: Municipal Health Secretariat, Rio de Janeiro, Scientific Computation Program, Oswaldo Cruz Foundation, Rio de Janeiro 5: Municipal Health Secretariat, Rio de Janeiro 6: Scientific Computation Program, Oswaldo Cruz Foundation, Rio de Janeiro 7: Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 8: Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 9: Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil 10: Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Publication date: 01 December 2014
The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.
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