Cost-effectiveness of Preventive Therapy for Tuberculosis with Isoniazid and Rifapentine Versus Isoniazid Alone in High-Burden Settings

Karl T. Johnson, Gavin J. Churchyard, Hojoon Sohn, David W. Dowdy

Research output: Contribution to journalArticle

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)1072-1078
Number of pages7
JournalClinical Infectious Diseases
Volume67
Issue number7
DOIs
StatePublished - Sep 14 2018

Keywords

  • HIV infections
  • cost-effectiveness analysis
  • isoniazid
  • latent tuberculosis
  • rifapentine

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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