Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland.
Aurum Health, Johannesburg, South Africa.
Clin Infect Dis. 2018 Sep 14;67(7):1072-1078. doi: 10.1093/cid/ciy230.
A short-course regimen of 3 months of weekly rifapentine and isoniazid (3HP) has recently been recommended by the World Health Organization as an alternative to at least 6 months of daily isoniazid (isoniazid preventive therapy [IPT]) for prevention of tuberculosis (TB). The contexts in which 3HP may be cost-effective compared to IPT among people living with human immunodeficiency virus are unknown.
We used a Markov state transition model to estimate the incremental cost-effectiveness of 3HP relative to IPT in high-burden settings, using a cohort of 1000 patients in a Ugandan HIV clinic as an emblematic scenario. Cost-effectiveness was expressed as 2017 US dollars per disability-adjusted life year (DALY) averted from a healthcare perspective over a 20-year time horizon. We explored the conditions under which 3HP would be considered cost-effective relative to IPT.
Per 1000 individuals on antiretroviral therapy in the reference scenario, treatment with 3HP rather than IPT was estimated to avert 9 cases of TB and 1 death, costing $9402 per DALY averted relative to IPT. Cost-effectiveness depended strongly on the price of rifapentine, completion of 3HP, and prevalence of latent TB. At a willingness to pay of $1000 per DALY averted, 3HP is likely to be cost-effective relative to IPT only if the price of rifapentine can be greatly reduced (to approximately $20 per course) and high treatment completion (85%) can be achieved.
3HP may be a cost-effective alternative to IPT in high-burden settings, but cost-effectiveness depends on the price of rifapentine, achievable completion rates, and local willingness to pay.
世界卫生组织最近建议，将 3 个月每周利福喷丁和异烟肼（3HP）短程方案替代至少 6 个月每日异烟肼（异烟肼预防治疗[IPT]），用于预防结核病（TB）。目前尚不清楚 3HP 在艾滋病毒感染者中与 IPT 相比可能具有成本效益的情况。
我们使用马尔可夫状态转移模型，以乌干达艾滋病毒诊所的 1000 名患者队列为代表情况，从医疗保健角度估计 3HP 相对于 IPT 的增量成本效益。成本效益以每避免一个残疾调整生命年（DALY）的 2017 年美元表示，在 20 年的时间内。我们探讨了 3HP 相对于 IPT 具有成本效益的条件。
在参考方案中，每 1000 名接受抗逆转录病毒治疗的个体中，与 IPT 相比，用 3HP 治疗估计可避免 9 例 TB 和 1 例死亡，相对于 IPT 每 DALY 避免 9402 美元的成本。成本效益强烈取决于利福平的价格、3HP 的完成情况和潜伏性 TB 的流行程度。在愿意支付 1000 美元/ DALY 的情况下，只有当利福平的价格大幅降低（每疗程约 20 美元）且能够实现高治疗完成率（85%）时，3HP 才可能相对 IPT 具有成本效益。
3HP 可能是高负担地区 IPT 的一种具有成本效益的替代方案，但成本效益取决于利福平的价格、可实现的完成率和当地的支付意愿。
