Shrestha R K, Mugisha B, Bunnell R, Mermin J, Odeke R, Madra P, Hitimana-Lukanika C, Adatu-Engwau F, Blandford J M
Global AIDS Program, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-48 Atlanta, Georgia 30333, USA.
Int J Tuberc Lung Dis. 2007 Jul;11(7):747-54.
Treatment of latent tuberculosis (TB) infection using isoniazid preventive therapy (IPT) in a human immunodeficiency virus (HIV) volunteer counseling and testing center in Kampala, Uganda.
To analyze the cost-utility of an IPT program for persons newly diagnosed with HIV.
The cost-utility analysis of the IPT program was conducted using Markov cohort simulation methods. Newly diagnosed HIV-infected persons were evaluated using tuberculin skin test (TST); those with positive TST were offered IPT for 9 months (targeted testing strategy). An alternative strategy of offering IPT to all HIV-infected clients without TST screening was also evaluated (treat all strategy). The cost-utility of targeted testing was compared to the 'no program' and the 'treat all' strategies.
The IPT program with the targeted testing strategy would produce 11 quality-adjusted life-years (QALYs) per 100 HIV-infected clients compared to no program. Offering IPT using the treat all strategy gained an additional 30 QALYs per 100 clients compared to targeted testing. Compared to no program, the incremental cost-utility of the targeted testing program was US$102/QALY gained. The cost-utility of the IPT program under the treat all strategy was US$106/QALY gained compared to the targeted testing strategy.
The provision of IPT for HIV-infected persons was cost-effective. The use of TST screening prior to IPT reduced costs per QALY gained, but saved fewer overall QALYs.
在乌干达坎帕拉的一个人类免疫缺陷病毒（HIV）自愿咨询和检测中心，采用异烟肼预防性治疗（IPT）对潜伏性结核感染进行治疗。
分析针对新诊断出感染HIV者的IPT项目的成本效益。
采用马尔可夫队列模拟方法对IPT项目进行成本效益分析。对新诊断出感染HIV的人进行结核菌素皮肤试验（TST）评估；TST呈阳性者接受9个月的IPT治疗（靶向检测策略）。还评估了另一种策略，即对所有未进行TST筛查的HIV感染患者提供IPT治疗（全部治疗策略）。将靶向检测的成本效益与“无项目”和“全部治疗”策略进行比较。
与无项目相比，采用靶向检测策略的IPT项目每100名HIV感染患者可产生11个质量调整生命年（QALY）。与靶向检测相比，采用全部治疗策略提供IPT治疗，每100名患者可额外获得30个QALY。与无项目相比，靶向检测项目的增量成本效益为每获得1个QALY 102美元。与靶向检测策略相比，全部治疗策略下IPT项目的成本效益为每获得1个QALY 106美元。
为HIV感染者提供IPT具有成本效益。在IPT治疗前使用TST筛查可降低每获得1个QALY的成本，但总体挽救的QALY较少。
