Re-evaluating the health impact and cost-effectiveness of tuberculosis preventive treatment for modern HIV cohorts on antiretroviral therapy: a modelling analysis using data from Tanzania.
Re-evaluating the health impact and cost-effectiveness of tuberculosis preventive treatment for modern HIV cohorts on antiretroviral therapy: a modelling analysis using data from Tanzania.
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DOI：
10.1016/s2214-109x(22)00372-2
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发表时间：
2022-11
影响因子：
34.3
通讯作者：
Menzies, Nicolas A.
中科院分区：
文献类型：
--
作者：
Zhu, Jinyi;Lyatuu, Goodluck;Sudfeld, Christopher R.;Kiravu, Anna;Sando, David;Machumi, Lameck;Minde, John;Chisonjela, Fikiri;Cohen, Ted;Menzies, Nicolas A.
异烟肼预防治疗（IPT）可以预防接受抗逆转录病毒治疗（ART）的人群中的结核病。根据检测和治疗指南，艾滋病毒规划目前正在启动接受抗逆转录病毒治疗的患者，这些患者的平均CD4细胞计数较高，结核病风险较低。我们的目的是调查这种变化如何影响IPT的健康影响和成本效益。我们利用坦桑尼亚达累斯萨拉姆的一个大型艾滋病毒治疗项目的数据，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211 748名开始抗逆转录病毒治疗的患者的长期健康和成本结果，分为三种情况：没有IPT治疗；观察到的IPT使用水平（75%）和完成程度（71%）；和完全（100%）IPT访问和完成。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获取水平估计避免了12 800（95%不确定区间7300至21 600）残疾调整生命年（DALYs），节省了23 000美元（- 26.8万至1 38.8万）。完全获得IPT将避免24500(15100至38300)DALY，成本为825000美元（- 594000至475.1万美元），相当于每个避免的DALY为23.4美元。据估计，在最近接受抗逆转录病毒治疗的队列中，IPT的终生健康益处更大，而终生成本则保持稳定。在亚组分析中，抗逆转录病毒治疗开始时较高的CD4细胞计数与IPT带来的更大健康收益相关（在抗逆转录病毒治疗开始时，CD4细胞计数为每μL 500个细胞，而CD4细胞计数<每μL 100个细胞，每10万例患者中，完全IPT避免了15 900[10 300至22 500]个DALYs），而7400[4500至11 600]个DALYs)和更低的增量生命周期成本。IPT对最近的抗逆转录病毒治疗群体来说仍然具有很高的成本效益或成本节约。据估计，随着患者在感染过程中较早地开始抗逆转录病毒治疗，IPT的健康影响和成本效益将得到改善。美国国立卫生研究院。
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.