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Re-Evaluating the Health Impact and Cost-Effectiveness of Tuberculosis Prevention for Modern ART Cohorts

2022

TB preventive therapy (TPT) is widely accepted to be cost-effective for reducing TB incidence in HIV-infected individuals receiving antiretroviral therapy (ART). However, as individuals initiate ART earlier in the course of disease, TB incidence is lower, and it is unclear how ART cost-effectiveness has changed.

This study assessed the cost-effectiveness of TPT in contemporary ART cohorts. The authors developed a microsimulation model of TB and HIV and parameterised it using data from a large HIV treatment programme in Dar es Salaam, Tanzania. They stratified results by ART initiation year and starting CD4 cell count. They found that IPT remains highly cost-effective or cost-saving for recent ART cohorts. Comparing the costs and lifetime health outcomes for individuals with early vs. later ART initiation, this study found that the economic case for TPT became stronger (lower cost-effectiveness ratios) with early ART initiation.

 

Source:

Zhu J, Lyatuu G, Sudfeld CR, Kiravu A, Sando D, Machumi L, Minde J, Chisonjela F, Cohen T, Menzies NA. Re-Evaluating the Health Impact and Cost-Effectiveness of Tuberculosis Prevention for Modern ART Cohorts: A Modelling Analysis. The Lancet Global Health 2022; 10 (11): e1646-e1654. https://doi.org/10.1016/S2214-109X(22)00372-2