Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Management and Development for Health, Dar es Salaam, Tanzania.
Lancet Glob Health. 2022 Nov;10(11):e1646-e1654. doi: 10.1016/S2214-109X(22)00372-2.
Isoniazid preventive therapy (IPT) can prevent tuberculosis among people receiving antiretroviral therapy (ART). HIV programmes are now initiating patients on ART with higher average CD4 cell counts and lower tuberculosis risks under test-and-treat guidelines. We aimed to investigate how this change has affected the health impact and cost-effectiveness of IPT.
We constructed a tuberculosis-HIV microsimulation model parameterised using data from a large HIV treatment programme in Dar es Salaam, Tanzania. We simulated long-term health and cost outcomes for the 211 748 individuals initiating ART between Jan 1, 2014, and Dec 31, 2020, under three scenarios: no IPT access; observed levels of IPT access (75%) and completion (71%); and full (100%) IPT access and completion. We stratified results by ART initiation year and starting CD4 cell count.
Observed levels of IPT access were estimated to have averted 12 800 (95% uncertainty interval 7300 to 21 600) disability-adjusted life-years (DALYs) and saved US$23 000 (-2 268 000 to 1 388 000). Full IPT access would have averted 24 500 (15 100 to 38 300) DALYs and cost $825 000 (-1 594 000 to 4 751 000), equivalent to $23·4 per DALY averted. Lifetime health benefits of IPT were estimated to be greater for more recent ART cohorts, while lifetime costs were stable. In subgroup analyses, a higher CD4 cell count at ART initiation was associated with greater health gains from IPT (15 900 [10 300 to 22 500] DALYs averted by full IPT per 100 000 patients for CD4 count >500 cells per μL at ART initiation, versus 7400 [4500 to 11 600] for CD4 count <100 cells per μL) and lower incremental lifetime costs.
IPT remains highly cost-effective or cost-saving for recent ART cohorts. The health impact and cost-effectiveness of IPT are estimated to improve as patients initiate ART earlier in the course of infection.
US National Institutes of Health.
异烟肼预防治疗 (IPT) 可预防接受抗逆转录病毒治疗 (ART) 的人群中的结核病。根据检测后治疗指南，艾滋病毒规划现在为更高平均 CD4 细胞计数和更低结核病风险的患者启动 ART。我们旨在研究这一变化如何影响 IPT 的健康影响和成本效益。
我们使用来自坦桑尼亚达累斯萨拉姆的一项大型艾滋病毒治疗计划的数据构建了一个结核病-艾滋病毒微观模拟模型。我们模拟了 2014 年 1 月 1 日至 2020 年 12 月 31 日期间接受 ART 的 211748 个人的长期健康和成本结果，共分为三种情况：没有 IPT 机会；观察到的 IPT 机会（75%）和完成率（71%）；以及完全（100%）IPT 机会和完成率。我们根据 ART 起始年份和起始 CD4 细胞计数对结果进行分层。
观察到的 IPT 机会水平估计避免了 12800（95%不确定区间为 7300 至 21600）残疾调整生命年（DALY），并节省了 2300 万美元（-2268 万美元至 1388 万美元）。完全 IPT 机会可避免 24500（15100 至 38300）DALY，并花费 82.5 万美元（-1594 万美元至 4751 万美元），相当于每避免一个 DALY 花费 23.4 美元。IPT 的终生健康效益估计对最近的 ART 队列更大，而终生成本保持稳定。在亚组分析中，ART 起始时 CD4 细胞计数较高与 IPT 带来的健康获益更大相关（完全 IPT 每 100000 名患者可避免 15900（10300 至 22500）DALY，而在 CD4 细胞计数 <100 细胞/μL 时为 7400（4500 至 11600）），并且增量终生成本更低。
IPT 对最近的 ART 队列仍然具有很高的成本效益或成本节约。IPT 的健康影响和成本效益估计随着患者在感染过程中更早地开始接受 ART 而得到改善。
美国国立卫生研究院。
