Bell J C, Rose D N, Sacks H S
Thomas C. Chalmers Clinical Trials Unit, Mount Sinai School of Medicine, New York, New York 10029, USA.
AIDS. 1999 Aug 20;13(12):1549-56. doi: 10.1097/00002030-199908200-00016.
Since antiretroviral therapy is largely unavailable to HIV-infected patients in developing countries and recent clinical trials have shown that tuberculosis (TB) preventive therapy can reduce TB and HIV-associated morbidity and mortality, we studied the effectiveness and cost-effectiveness of TB preventive therapy for HIV-infected persons in sub-Saharan Africa.
A Markov model that used results of clinical trials of TB preventive therapy in sub-Saharan Africa and literature-derived medical care costs was used to evaluate three preventive therapy regimens in HIV-infected, tuberculin-positive patients in Uganda: (1) daily isoniazid (INH) for 6 months, (2) daily INH and rifampin (RIF) for 3 months, and (3) twice-weekly RIF and pyrazinamide (PZA) for 2 months.
All three regimens extend life expectancy and reduce the number of TB cases. When only medical care costs are considered, all three preventive therapy regimens cost more than not providing preventive therapy to extend life and prevent active tuberculosis. When medical care and social costs are considered together, 6-months of daily INH treatment will save money relative to no preventive therapy and when the costs associated with treating secondary infections are included, all three preventive therapy regimens are less expensive than no preventive therapy. With the inclusion of secondary infection costs, 6 months of daily INH results in savings of $24.16 per person.
TB preventive therapy taken by HIV-infected tuberculin reactors in sub-Saharan Africa results in extended life-expectancy, reduction of the incidence of TB and monetary savings in medical care and social costs. TB control policy in sub-Saharan Africa should include preventive therapy.
由于发展中国家的艾滋病毒感染患者基本无法获得抗逆转录病毒治疗，且近期临床试验表明结核病（TB）预防性治疗可降低结核病及与艾滋病毒相关的发病率和死亡率，我们研究了撒哈拉以南非洲地区针对艾滋病毒感染者的结核病预防性治疗的有效性和成本效益。
采用一个马尔可夫模型，该模型使用了撒哈拉以南非洲地区结核病预防性治疗的临床试验结果以及文献得出的医疗成本，来评估乌干达艾滋病毒感染且结核菌素呈阳性患者的三种预防性治疗方案：（1）每日服用异烟肼（INH）6个月；（2）每日服用异烟肼和利福平（RIF）3个月；（3）每周两次服用利福平和吡嗪酰胺（PZA）2个月。
所有三种方案均能延长预期寿命并减少结核病病例数。仅考虑医疗成本时，所有三种预防性治疗方案的花费都高于不提供预防性治疗以延长寿命和预防活动性结核病的花费。当综合考虑医疗和社会成本时，每日服用异烟肼6个月相对于不进行预防性治疗可节省费用，且当计入与治疗继发感染相关的成本时，所有三种预防性治疗方案的花费都低于不进行预防性治疗。计入继发感染成本后，每日服用异烟肼6个月每人可节省24.16美元。
撒哈拉以南非洲地区艾滋病毒感染且结核菌素反应呈阳性者接受结核病预防性治疗可延长预期寿命、降低结核病发病率，并在医疗和社会成本方面节省资金。撒哈拉以南非洲地区的结核病控制政策应包括预防性治疗。
