1 / 13

July, 2013 Kuala Lumpur, Malaysia

Cost-effectiveness of ART and the Three I’s for HIV/TB to prevent tuberculosis among people living with HIV. Somya Gupta, Taiwo Abimbola , Anand Date, Amitabh B. Suthar , Rod Bennett , Nalinee Sangrujee , Reuben Granich. July, 2013 Kuala Lumpur, Malaysia.

elvina
Download Presentation

July, 2013 Kuala Lumpur, Malaysia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Cost-effectiveness of ART and the Three I’s for HIV/TB to prevent tuberculosis among people living with HIV Somya Gupta, TaiwoAbimbola, AnandDate, Amitabh B. Suthar, Rod Bennett, NalineeSangrujee, Reuben Granich July, 2013 Kuala Lumpur, Malaysia

  2. The Three I’s for HIV/TB activities

  3. Person living with HIV (including pregnant women and those on ART) Screen for TB using: Current cough; Fever; Weight loss; Night Sweat No Yes • Assess IPT contraindications Investigate for TB & other disease No Yes Other diagnosis Not TB TB Appropriate treatment & consider IPT Follow up; consider IPT Treat for TB Give IPT Defer IPT WHO 2011 IPT/ICF recommendations * Duration of IPT: 6 months (conditional recommendation: 36 months)

  4. Objective of analysis Evaluate the health outcomes, costs, and cost-effectiveness of policy scenarios with different TB prevention interventions • Expanded ART coverage of 90% • (at CD4 count ≤ 350 cells/mm3) • ICF using four-symptom screening • IPT for all/TST+ for 6 or 36 months • Outcomes: • 1. TB cases • 2. Total costs • 3. Cost-effectiveness • TB infection control in • health-care facilities • Base scenario: • 55% ART coverage • Standard TB screening (cough)

  5. Policy alternatives TB diagnostic algorithms: Sputum smear microscopy and chest radiography Xpert MTB/RIF

  6. Methodology • Developed decision-analytic model to evaluate policies • Setting : generalized HIV epidemic with active TB prevalence of 5% • Population : cohort of 10,000 people living with HIV presenting to health facilities • Timeframe and analytic horizon : 36 months • Model parameters taken from published studies • Costs (2010 USD) : healthcare utilization costs from South Africa

  7. Cost-effectiveness analysis • All policy alternatives were evaluated for TB cases and total cost over 3 years • ICER = Difference in total costs Difference in TB cases • Strategies excluded: • Strongly dominated (higher cost and less TB cases prevented) • Weakly dominated (higher ICER than the next alternative) • ICER calculated for the cost-effective strategies

  8. Results TB diagnostic algorithm: Sputum smear and chest radiography --- non-dominated

  9. Results TB diagnostic algorithm: Xpert MTB/RIF --- non-dominated

  10. ICER for cost-effective strategies TB diagnostic algorithm: Sputum smear and chest radiography TB diagnostic algorithm: Xpert MTB/RIF Incremental cost-effectiveness ratio (ICER) is expressed in US $ per TB case averted

  11. Limitations • Impact of ART at CD4 count ≤ 500 cells/mm3 and immediate ART on TB incidence not considered • Cost of developing and maintaining diagnostic capacity excluded • Efficacy and cost of TB infection control package are an estimate • Estimated the costs and health benefits of one-time TB screening per person over 3 years

  12. Conclusion and recommendation • Combination strategy with expanded ART coverage, infection control and 36-months IPT averted the most TB cases • Combination TB prevention strategy was more cost-effective when compared with other strategies • Accelerated scale-up of ART and the Three I’s for HIV/TBwill reduce TB burden among people living with HIV

  13. Thank you… Reuben Granich (UNAIDS) TaiwoAbimbola (CDC) AnandDate (CDC) Rod Bennett (Hexor) Amitabh Suthar (consultant) NalineeSangrujee (CDC)

More Related