Health economic analyses of latent tuberculosis infection screening and preventive treatment among people living with HIV in lower tuberculosis incidence settings: a systematic review

Wellcome Open Research

article

Rebecca F. Baggaley¹  Carolin Vegvari²  Christian A. Dimala¹  Marc Lipman⁴  Robert F. Miller⁵  James Brown⁵  Svetlana Degtyareva⁶  Helena A. White⁷  T. Déirdre Hollingsworth⁸  Manish Pareek⁷ 

[1] Department of Population Health Sciences, University of Leicester;Department of Infectious Disease Epidemiology, Imperial College London;UCL Respiratory, University College London;Royal Free London National Health Service Foundation Trust;RUDN University;Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust;Big Data Institute, University of Oxford;Oriole Global Health Ltd;Department of Respiratory Sciences, University of Leicester

关键词: HIV;    latent tuberculosis;    screening;    health economic;    cost-effectiveness;    cost-utility;    model;    review;   

DOI  :  10.12688/wellcomeopenres.16604.2

学科分类：内科医学

来源: Wellcome

【 摘 要 】

Introduction: In lower tuberculosis (TB) incidence countries (<100 cases/100,000/year), screening and preventive treatment (PT) for latent TB infection (LTBI) among people living with HIV (PLWH) is often recommended, yet guidelines advising which groups to prioritise for screening can be contradictory and implementation patchy. Evidence of LTBI screening cost-effectiveness may improve uptake and health outcomes at reasonable cost.Methods: Our systematic review assessed cost-effectiveness estimates of LTBI screening/PT strategies among PLWH in lower TB incidence countries to identify model-driving inputs and methodological differences. Databases were searched 1980-2020. Studies including health economic evaluation of LTBI screening of PLWH in lower TB incidence countries (<100 cases/100,000/year) were included.Results: Of 2,644 articles screened, nine studies were included. Cost-effectiveness estimates of LTBI screening/PT for PLWH varied widely, with universal screening/PT found highly cost-effective by some studies, while only targeting to high-risk groups (such as those from mid/high TB incidence countries) deemed cost-effective by others. Cost-effectiveness of strategies screening all PLWH from studies published in the past five years varied from US$2828 to US$144,929/quality-adjusted life-year gained (2018 prices). Study quality varied, with inconsistent reporting of methods and results limiting comparability of studies. Cost-effectiveness varied markedly by screening guideline, with British HIV Association guidelines more cost-effective than NICE guidelines in the UK.Discussion: Cost-effectiveness studies of LTBI screening/PT for PLWH in lower TB incidence settings are scarce, with large variations in methods and assumptions used, target populations and screening/PT strategies evaluated. The limited evidence suggests LTBI screening/PT may be cost-effective for some PLWH groups but further research is required, particularly on strategies targeting screening/PT to PLWH at higher risk. Standardisation of model descriptions and results reporting could facilitate reliable comparisons between studies, particularly to identify those factors driving the wide disparity between cost-effectiveness estimates.Registration: PROSPEROCRD42020166338 (18/03/2020).

【 授权许可】

CC BY