Cost-effectiveness of initiating antiretroviral therapy at different points in TB treatment in HIV-TB co-infected ambulatory patients in South Africa

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Naidoo, Kogieleum ; Grobler, Anneke C ; Deghaye, Nicola ; Reddy, Tarylee ; Gengiah, Santhanalakshmi ; Gray, Andrew ; Karim, Salim Abdool
• 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.
  
  
• Subjects:
  Anti-HIV Agents Antitubercular Agents Cost-Benefit Analysis Drug Administration Schedule Health Care Costs HIV Infections Humans South Africa 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 HHSUnited States/ ; U2G PS001350/PS/NCHHSTP CDC HHSUnited States/
• Volume:
  69
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:1a9d8d591976758ece922aa5bb3bc23dc40917d326b00f5a4d0c57e9e8855192
• Download URL:
  https://stacks.cdc.gov/view/cdc/32070/cdc_32070_DS1.pdf
• File Type:
  [PDF - 376.00 KB ]