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Intensive case finding and isoniazid preventative therapy in HIV infected individuals in Africa : economic model and value of information analysis
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Cattamanchi, Adithya, Maheswaran, Hendramoorthy and Barton, Pelham (2012) Intensive case finding and isoniazid preventative therapy in HIV infected individuals in Africa : economic model and value of information analysis. PLoS One, 7 (1). e30457. doi:10.1371/journal.pone.0030457 ISSN 1932-6203.
An open access version can be found in:
Official URL: http://dx.doi.org/10.1371/journal.pone.0030457
Abstract
Background
Tuberculosis (TB) accounts of much of the morbidity and mortality associated with HIV. We evaluate the cost-effectiveness of different strategies to actively screen for TB disease in HIV positive individuals, where isoniazid preventative therapy (IPT) is given to those screening negative, and use value of information analysis (VOI) to identify future research priorities.
Methodology/ Principal Findings
We built an individual sampling model to investigate the costs (2010 US Dollars) and consequences of screening for TB, and providing TB treatment or IPT in adults testing HIV positive in Sub-Saharan Africa. A systematic review and meta-analysis was conducted to assess performance of the nine different TB screening strategies evaluated. Probabilistic sensitivity analysis was conducted to incorporate decision uncertainty, and expected value of perfect information for the entire model and for groups of parameters was calculated. Screening all HIV infected individuals with sputum microscopy was the least costly strategy, with other strategies not cost-effective at WHO recommended thresholds. Screening those with TB symptoms with sputum microscopy and CXR would be cost-effective at a threshold ICER of $7,800 per quality-adjusted life year (QALY), but associated with significant uncertainty. VOI analysis suggests further information would be of value.
Conclusions/ Significance
Resource-constrained countries in sub-Saharan Africa wishing to scale up TB preventative services in their HIV infected populations should consider expanding laboratory facilities to enable increased screening for TB with sputum microscopy, whilst improved estimates of the TB prevalence in the population to be screened are needed, as it may influence the optimal strategy.
| Item Type: | Journal Article | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
| Journal or Publication Title: | PLoS One | ||||||||
| Publisher: | Public Library of Science | ||||||||
| ISSN: | 1932-6203 | ||||||||
| Official Date: | 23 January 2012 | ||||||||
| Dates: |
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| Volume: | 7 | ||||||||
| Number: | 1 | ||||||||
| Article Number: | e30457 | ||||||||
| DOI: | 10.1371/journal.pone.0030457 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Adapted As: | |||||||||
| Open Access Version: |
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