Cost-effectiveness of isoniazid preventive therapy for HIVinfected pregnant women in India

S. Kapoor, A. Gupta, M. Shah

Research output: Contribution to journalArticle

Abstract

Background: India has a high burden of active tuberculosis (TB) and human immunodeficiency virus (HIV) infection. Pregnancy increases the risks of developing TB in HIV-infected women. Isoniazid preventive therapy (IPT) reduces progression to TB, but may increase costs and hepatotoxicity. The costeffectiveness of IPT for HIV-infected pregnant women in India is unknown. DESIGN: We evaluated the cost-effectiveness of antepartum IPT among HIV-infected women in India using a decision-analytic model. We compared current practice (no IPT) with: Intervention 1 (IPT regardless of CD4 count) and Intervention 2 (IPT for those with CD4 count ≤ 200 cells/μl). We modeled IPT irrespective of tuberculin skin test (TST) status and TST-driven strategies. Primary outcomes were anticipated costs, disability-adjusted life-years (DALYs) and TB cases. R ESULT S: Both IPT interventions are highly costeffective compared to no IPT at current willingness-topay thresholds (respectively US$178.00 and US$201.00 per DALY averted for Interventions 1 and 2). However, providing IPT irrespective of CD4 count results in the greatest health benefits (21 TB cases averted/1000 patients) compared to current practice. IPT irrespective of TSTstatus was also highly cost-effective compared to TST-driven IPT (respectively US$1027.00 and US$1154.00/DALY averted for Interventions 1 and 2). CONCLUS ION: Antepartum IPT for HIV-infected women is highly cost-effective for TB prevention compared to current practices in India.

Original languageEnglish (US)
Pages (from-to)85-92
Number of pages8
JournalInternational Journal of Tuberculosis and Lung Disease
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2016

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Keywords

  • Economic evaluation
  • IPT
  • Pregnancy
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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