Table 2.
Costs and effects of IPT compared to standard of care in base case
| Variable | Intervention 1: IPT for all patients (95%UR)* | Intervention 2: IPT for patients with CD4 ≤ 200 cells/μl (95%UR)* | Standard of care: no IPT (95%UR)* |
|---|---|---|---|
| Costs, USD | |||
| Net costs per individual | 22.53 (15.02 to 69.27) | 4.28 (3.76 to 35.02) | 2.27 (1.03 to 10.45) |
| Incremental | 20.26 (10.69 to 65.82) | 2.01 (1.04 to 30.44) | Reference |
| Total health system costs* | 1 103 970 (735 980 to 3 394 280) | 209 720 (184 240 to 1 715 980) | 111 230 (50 470 to 512 050) |
| Incremental | 992 740 (523 810 to 3 225 180) | 98 490 (50 960 to 1 491 560) | Reference |
| Effects | |||
| DALYs per individual | 20.287 (20.105 to 23.614) | 20.391 (20.245 to 20.863) | 20.401 (20.284 to 23.837) |
| Incremental | 0.114 (0.033 to 0.785) | 0.010 (0.002 to 0.319) | Reference |
| Total health system DALYs† | 994 063 (985 145 to 1 157 086) | 999 159 (992 005 to 1 169 287) | 999 649 (993 916 to 1 168 013) |
| Incremental | 5 586 (1 617 to 38 465) | 490 (98 to 15 631) | Reference |
| TB or IPT deaths (deaths/1000 patients)‡ | 11 (8 to 74) | 19 (12 to 107) | 21 (14 to 129) |
| Incremental | 10 (4 to 77) | 2 (1 to 40) | Reference |
| Total health system deaths† | 539 (392 to 3 626) | 931 (588 to 5 243) | 1470 (686 to 6 321) |
| Incremental | 490 (196 to 3 773) | 98 (49 to 1 960) | Reference |
| Active TB (cases/1 000 patients) | 16 (9 to 100) | 34 (17 to 150) | 37 (20 to 184) |
| Incremental | 21 (11 to 112) | 3 (2 to 64) | Reference |
| Total health system active TB cases** | 784 (441 to 4 900) | 1 666 (833 to 7 350) | 1813 (980 to 9 016) |
| Incremental | 1 029 (539 to 5 488) | 147 (98 to 3 136) | Reference |
| Cost-effectiveness (ICERs)§ | |||
| USD/DALY averted | 178 (23 to 1 309) | 201 (19 to 1 197) | Reference |
| USD/DALY averted | 176 (−309 to 343) | Reference | — |
95% URs were calculated based on probabilistic sensitivity analysis using Monte-Carlo simulation methods in which all key parameters are varied across their uncertainty ranges simultaneously.
Total health system costs and effects were calculated based on an estimated population size of 49 000 HIV-infected pregnant women entering the system every year in India. Costs and effects included those associated with IPT usage, but also downstream costs and effects associated with hepatotoxicity, active TB diagnosis and treatment.9
Deaths due to active TB disease or IPT-related hepatotoxicity.
Calculated as incremental costs divided by incremental effects (costs per DALYs averted).
IPT = isoniazid preventive therapy; UR = uncertainty range; USD = US dollar; TB = tuberculosis; DALY = disability-adjusted life-years; ICER = incremental cost-effectiveness ratio.