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dc.contributor.authorPho, Mai T.
dc.contributor.authorSwaminathan, Soumya
dc.contributor.authorKumarasamy, Nagalingeswaran
dc.contributor.authorLosina, Elena
dc.contributor.authorPonnuraja, C.
dc.contributor.authorUhler, Lauren M.
dc.contributor.authorScott, Callie A.
dc.contributor.authorMayer, Kenneth Hugh
dc.contributor.authorFreedberg, Kenneth Alan
dc.contributor.authorWalensky, Rochelle P.
dc.date.accessioned2013-03-05T14:50:04Z
dc.date.issued2012
dc.identifier.citationPho, Mai T., Soumya Swaminathan, Nagalingeswaran Kumarasamy, Elena Losina, C. Ponnuraja, Lauren M. Uhler, Callie A. Scott, Kenneth H. Mayer, Kenneth A. Freedberg, and Rochelle P. Walensky. 2012. The cost-effectiveness of tuberculosis preventive therapy for hiv-infected individuals in southern India: A trial-based analysis. PLoS ONE 7(4): e36001.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10364585
dc.description.abstractBackground: Regimens for isoniazid-based preventive therapy (IPT) for tuberculosis (TB) in HIV-infected individuals have not been widely adopted given concerns regarding efficacy, adherence and drug resistance. Further, the cost-effectiveness of IPT has not been studied in India. Methods We used an HIV/TB model to project TB incidence, life expectancy, cost and incremental cost-effectiveness of six months of isoniazid plus ethambutol (6EH), thirty-six months of isoniazid (36H) and no IPT for HIV-infected patients in India. Model input parameters included a median CD4 count of 324 cells/mm\(^3\), and a rate ratio of developing TB of 0.35 for 6EH and 0.22 for 36H at three years as compared to no IPT. Results of 6EH and 36H were also compared to six months of isoniazid (6H), three months of isoniazid plus rifampin (3RH) and three months of isoniazid plus rifapentine (3RPTH). Results: Projected TB incidence decreased in the 6EH and 36H regimens by 51% and 62% respectively at three-year follow-up compared to no IPT. Without IPT, projected life expectancy was 136.1 months at a lifetime per person cost of $5,630. 6EH increased life expectancy by 0.8 months at an additional per person cost of $100 (incremental cost-effectiveness ratio (ICER) of $1,490/year of life saved (YLS)). 36H further increased life expectancy by 0.2 months with an additional per person cost of $55 (ICER of $3,120/YLS). The projected clinical impact of 6EH was comparable to 6H and 3RH; however when compared to these other options, 6EH was no longer cost-effective given the high cost of ethambutol. Results were sensitive to baseline CD4 count and adherence. Conclusions: Three, six and thirty-six-month regimens of isoniazid-based therapy are effective in preventing TB. Three months of isoniazid plus rifampin and six-months of isoniazid are similarly cost-effective in India, and should be considered part of HIV care.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0036001en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340407/pdf/en_US
dash.licenseLAA
dc.subjectBiologyen_US
dc.subjectComputational Biologyen_US
dc.subjectPopulation Modelingen_US
dc.subjectInfectious Disease Modelingen_US
dc.subjectMedicineen_US
dc.subjectClinical Research Designen_US
dc.subjectModelingen_US
dc.subjectGlobal Healthen_US
dc.subjectInfectious Diseasesen_US
dc.subjectBacterial Diseasesen_US
dc.subjectTuberculosisen_US
dc.subjectViral Diseasesen_US
dc.subjectHIVen_US
dc.subjectPublic Healthen_US
dc.subjectPreventive Medicineen_US
dc.subjectSocial and Behavioral Sciencesen_US
dc.subjectEconomicsen_US
dc.subjectHealth Economicsen_US
dc.subjectCost-Effectiveness Analysisen_US
dc.titleThe Cost-Effectiveness of Tuberculosis Preventive Therapy for HIV-Infected Individuals in Southern India: A Trial-Based Analysisen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorLosina, Elena
dc.date.available2013-03-05T14:50:04Z
dc.identifier.doi10.1371/journal.pone.0036001*
dash.contributor.affiliatedMayer, Kenneth
dash.contributor.affiliatedFreedberg, Kenneth
dash.contributor.affiliatedWalensky, Rochelle
dash.contributor.affiliatedLosina, Elena
dc.identifier.orcid0000-0001-7460-733X
dc.identifier.orcid0000-0002-3424-0892


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