Cost-Effectiveness of HIV Testing Referral Strategies among Tuberculosis Patients in India

Uhier, L M and Kumarasamy, N and Mayer, K H and Saxena, A and Losina, E and Muniyandi, M and Stoler, A W and Lu, Z and Walensky, R P and Flanigan, T P and Bener, M A and Freedberg, K A and Swaminathan, Soumya and CEPAC, International Investigators (2010) Cost-Effectiveness of HIV Testing Referral Strategies among Tuberculosis Patients in India. PLOS One, 5 (9). e12747. ISSN Electronic: 1932-6203

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Abstract

Background: Indian guidelines recommend routine referral for HIV testing of all tuberculosis (TB) patients in the nine states with the highest HIV prevalence, and selective referral for testing elsewhere. We assessed the clinical impact and costeffectiveness of alternative HIV testing referral strategies among TB patients in India. Methods and Findings: We utilized a computer model of HIV and TB disease to project outcomes for patients with active TB in India. We compared life expectancy, cost, and cost-effectiveness for three HIV testing referral strategies: 1) selective referral for HIV testing of those with increased HIV risk, 2) routine referral of patients in the nine highest HIV prevalence states with selective referral elsewhere (current standard), and 3) routine referral of all patients for HIV testing. TB-related data were from the World Health Organization. HIV prevalence among TB patients was 9.0% in the highest prevalence states, 2.9% in the other states, and 4.9% overall. The selective referral strategy, beginning from age 33.50 years, had a projected discounted life expectancy of 16.88 years and a mean lifetime HIV/TB treatment cost of US$100. The current standard increased mean life expectancy to 16.90 years with additional per-person cost of US$10; the incremental costeffectiveness ratio was US$650/year of life saved (YLS) compared to selective referral. Routine referral of all patients for HIV testing increased life expectancy to 16.91 years, with an incremental cost-effectiveness ratio of US$730/YLS compared to the current standard. For HIV-infected patients cured of TB, receiving antiretroviral therapy increased survival from 4.71 to 13.87 years. Results were most sensitive to the HIV prevalence and the cost of second-line antiretroviral therapy. Conclusions: Referral of all patients with active TB in India for HIV testing will be both effective and cost-effective. While effective implementation of this strategy would require investment, routine, voluntary HIV testing of TB patients in India should be recommended.

Affiliation:	ICMR-National Institute for Research in Tuberculosis
Item Type:	Article
Uncontrolled Keywords:	Cost-effectiveness, HIV, tuberculosis, India
Subjects:	Tuberculosis > Epidemiological Research
Divisions:	Epidemiology
Depositing User:	Dr. Rathinasabapati R
Date Deposited:	31 May 2022 10:50
Last Modified:	31 May 2022 10:50
URI:	http://eprints.nirt.res.in/id/eprint/1063

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