Details:

Alternative Title:
J Acquir Immune Defic Syndr
Personal Author:
Naidoo, Kogieleum ; Grobler, Anneke C ; Deghaye, Nicola ; Reddy, Tarylee ; Gengiah, Santhanalakshmi ; ... More +
Naidoo, Kogieleum ; Grobler, Anneke C ; Deghaye, Nicola ; Reddy, Tarylee ; Gengiah, Santhanalakshmi ; Gray, Andrew ; Karim, Salim Abdool Less -
Description:
Objective

Initiation of antiretroviral therapy (ART) during tuberculosis (TB) treatment improves survival in TB-HIV co-infected patients. In patients with CD4+ counts <50cells/mm3, there is a substantial clinical and survival benefit of early ART initiation. The purpose of this study was to assess the costs and cost effectiveness of starting ART at various time points during TB treatment in patients with CD4+ counts ≥50cells/mm3.

Methods

In the SAPiT trial, 642 HIV-TB co-infected patients were randomized to three arms, either receiving ART within 4 weeks of starting TB treatment (early treatment arm; Arm-1), after the intensive phase of TB treatment (late treatment arm; Arm-2), or after completing TB treatment (sequential arm; Arm-3). Direct healthcare costs were measured from a provider perspective using a micro-costing approach. The incremental cost per death averted was calculated using the trial outcomes.

Results

For patients with CD4+ count≥50cells/mm3, median monthly variable costs per patient were $116, $113 and $102 in Arms-1, -2 and -3, respectively. There were 12 deaths in 177 patients in Arm-1, 8 deaths in 180 patients in the Arm-2 and 19 deaths in 172 patients in Arm-3. While the costs were lower in Arm-3, it had a substantially higher mortality rate. The incremental cost per death averted associated with moving from Arm-3 to Arm-2 was $4199. There was no difference in mortality between Arm-1 and Arm-2, but Arm-1 was slightly more expensive.

Conclusions

Initiation of ART after the completion of the intensive phase of TB treatment is cost effective for patients with CD4+ counts≥50cells/mm3.


Subject:
[+]
Anti-HIV Agents
Antitubercular Agents
Cost-Benefit Analysis
Drug Administration Schedule
Health Care Costs
HIV Infections
Humans
Tuberculosis

Source:
J Acquir Immune Defic Syndr. 69(5):576-584
Pubmed ID:
26167618
Pubmed Central ID:
PMC4503368
Document Type:
Journal Article
Funding:
U19 AI051794/AI/NIAID NIH HHS/United States ; U2G PS001350/PS/NCHHSTP CDC HHS/United States
U19 AI051794/AI/NIAID NIH HHS/United States ; U2G PS001350/PS/NCHHSTP CDC HHS/United States Less -
Place as Subject:
South Africa
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:1a9d8d591976758ece922aa5bb3bc23dc40917d326b00f5a4d0c57e9e8855192
File Type:

Supporting Files

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