Journal of Tropical Medicine / 2011 / Article / Tab 1

Review Article

A Systematic Review of Economic Evaluations of Chemoprophylaxis for Tuberculosis

Table 1

Summary of selected studies.
(a)

Study objectiveStudy population and setting

Rose et al. [11]To compare TB prevention with isoniazid (INH) chemoprophylaxis to no intervention, for low risk as well as high-risk tuberculin reactorsMen aged 20, recently infected with tubercle bacillus and thus at high risk; men aged 55, older tuberculin reactors having low risk of activation US

Salpeter et al. [12]To evaluate the effectiveness and cost effectiveness of monitored INH prophylaxis for low-risk tuberculin reactors older than 35 years of age35, 50 and 70-year-old low risk tuberculin reactors who have normal chest radiograph and are not at increased risk of tuberculin activation US

Jasmer et al. [13]To determine cost effectiveness of rifampin-pyrazinamide (RZ) for 2 months compared with INH for 6 months for treatment of latent tuberculosis in adults without HIV infectionAdult aged 17 years or older with a tuberculin skin test result, in whom active TB is excluded and in whom treatment of latent TB infection would ordinarily be recommended; exclusion criteria are pregnancy, HIV infection, and history of gout US

Diel et al. [14]To perform a cost-effectiveness analysis in young-and middle-aged adults with latent tuberculosis infection20- and 40-year old close contacts of active TB cases with positive Mantoux test and in whom active TB is excluded Germany

Holland et al. [15]To evaluate cost and cost effectiveness of different regimens for treatment of LTBIHypothetical cohort of individuals with LTBI contacts of infectious case, all adults with average age of 39 years US

Tan et al. [16]To evaluate cost effectiveness of LTBI therapy for different TB contact population defined by important risk factors and to propose optimal policy based on different recommendations for each subgroup of contactTB contacts with tuberculin test size ≥5 mm, defined by age group (<10 y/o or above), ethnicity (Canadian born/foreign born), BCG vaccination status British Columbia, Canada

Fitzgerald and Gafni [17]To evaluate role of INH prophylaxis in low-risk patients with positive Mantoux test result and identify most efficient use of health care resources20-, 50-, and 70-years-old low-risk patients with positive Mantoux test Canada

Ziakas and Mylonakis [18]To compare efficacy, toxicity, and cost of the 4-month Rifampin treatment (4RIF) with the standard 9-month INH strategy (9INH) from pooled meta-analysis of published clinical studiesPatient-related data from eight Canadian centres, two US centres, one Saudi Arabian centre, and one Brazilian centre

(b)

Measure of outcomesCost effectivenessImplications

Rose et al. [11]Life years gained, quality-adjusted life years (QALYs)
Incremental cost effectiveness ratio (ICER)
For high-risk reactors over 35, isoniazid dominates no intervention; cost savings and greater benefits (increased life expectancy).
For low-risk reactors over 35, ICER of isoniazid over no intervention of $12,625 per year of life gained and $35,011 per death averted
Study can contribute to a change in existing policy and practice; consideration of INH therapy for all infected persons irrespective of age group and risk of tuberculin reactors

Salpeter et al. [12]Number needed to treat,
life years gained, and probability of survival at 1-year
Cost saving
Isoniazid dominates no intervention for 35, 50 and 70 year olds; cost savings and increased life expectancyStudy can contribute to a change in existing policy and practice; consideration of all age groups for preventive therapy leading to potential public health benefits

Jasmer et al. [13]Number of TB cases averted, number of TB-related deaths ICERIsoniazid dominates no intervention; cost savings and increased life expectancy, more deaths prevented Isoniazid costs less than rifampin-pyrazinamide; both treatments have the same gain in life expectancy
ICER of rifampin over no intervention of $2,494 per case prevented
Justify existing policy of INH prophylaxis

Diel et al. [14]Number needed to treat, number of TB-related deaths avoided
Cost saving
Isoniazid dominates no intervention for 20 and 40 year olds; cost savings, more cases, and TB-related deaths preventedAcceleration of expansion of INH prevention

Holland et al. [15]Life years gained,
QALYs
ICER
Rifampin dominates (self-administered and, directly observed) isoniazid; cost savings and more QALYs gained, more cases of active TB-prevented
ICER of isoniazid-rifapentine over rifampinof $48,999 per QALY gained
Study can contribute to a change in existing policy and practice; highlights important knowledge gaps

Tan et al. [16]Number of active TB cases prevented, QALYs
Net monetary benefit
Test and treat (with isoniazid) more cost effective (in terms of net monetary benefit, the difference between benefits, valued at $50,000 per QALY, and costs) than no screening and treat all, for most subgroupsJustifies existing policy; support current practice of provision of treatment on the basis of TST size; exclusion of low-risk groups from screening and providing treatment to high-risk contacts without screening could improve the performance of the program

Fitzgerald and Gafni [17]Number of TB cases prevented, life years gained
Direct as well as indirect costs in different age groups
Average cost per case prevented in low-risk patients by isoniazid of $8,586 (20-year old), $28,260 (50 year old), and $40,102 (70-year old)Justifies existing policy of INH prophylaxis; considers of all age groups; highlights importance of including indirect as well as direct costs

Ziakas and Mylonakis [18]Hepatotoxicity, compliance
Cost saving
Rifampin dominates isoniazid; cost savings and lower risk of noncompletion, lower rate of hepatotoxicityJustifies existing policy; 9INH therapy is considered as standard of care

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