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

Citation: Kapoor S, Gupta A, Shah M. Cost effectiveness of isoniazid preventive therapy for HIV-infected pregnant women in India. Int J Tuberc Lung Dis. 2016 Jan;20(1):85-92. doi: 10.5588/ijtld.15.0391. PMID: 26688533. PMCID: PMC4992362.

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https://www.ncbi.nlm.nih.gov/pubmed/26688533

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 cost-effectiveness 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.

RESULTS:

Both IPT interventions are highly cost-effective compared to no IPT at current willingness-to-pay 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 TST status 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).

CONCLUSION:

Antepartum IPT for HIV-infected women is highly cost-effective for TB prevention compared to current practices in India.

Int J Tuberc Lung Dis. 2016:20(1).

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