title: Cost-effectiveness of tuberculosis screening and isoniazid treatment in the TB/HIV in Rio (THRio) Study.
abstract: OBJECTIVE
  To estimate the incremental cost-effectiveness of tuberculosis (TB) screening and isoniazid preventive therapy (IPT) among human immunodeficiency virus (HIV) infected adults in Rio de Janeiro, Brazil.
  
  
  METHODS
  We used decision analysis, populated by data from a cluster-randomized trial, to project the costs (in 2010 USD) and effectiveness (in disability-adjusted life years [DALYs] averted) of training health care workers to implement the tuberculin skin test (TST), followed by IPT for TST-positive patients with no evidence of active TB. This intervention was compared to a baseline of usual care. We used time horizons of 1 year for the intervention and 20 years for disease outcomes, with all future DALYs and medical costs discounted at 3% per year.
  
  
  RESULTS
  Providing this intervention to 100 people would avert 1.14 discounted DALYs (1.57 undiscounted DALYs). The median estimated incremental cost-effectiveness ratio was $2273 (IQR $1779-$3135) per DALY averted, less than Brazil's 2010 per capita gross domestic product (GDP) of $11,700. Results were most sensitive to the cost of providing the training.
  
  
  CONCLUSIONS
  Training health care workers to screen HIV-infected adults with TST and provide IPT to those with latent tuberculous infection can be considered cost-effective relative to the Brazilian GDP per capita.
authors.affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: M
authors.initials: M
authors.lastname: Azadi
authors.affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Bishai
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Dowdy
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Moulton
authors.affiliation: Municipal Health Secretariat, Rio de Janeiro, Brazil.
authors.forename: S
authors.initials: S
authors.lastname: Cavalcante
authors.affiliation: Municipal Health Secretariat, Rio de Janeiro, Brazil.
authors.forename: V
authors.initials: V
authors.lastname: Saraceni
authors.affiliation: Scientific Computation Program, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
authors.forename: A G
authors.initials: AG
authors.lastname: Pacheco
authors.affiliation: Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: S
authors.initials: S
authors.lastname: Cohn
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Chaisson
authors.affiliation: Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: B
authors.initials: B
authors.lastname: Durovni
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Golub
mesh_terms: D000488:Allied Health Personnel / Q000191:economics / Q000193:education; D000995:Antitubercular Agents / Q000191:economics* / Q000627:therapeutic use*; D001431:Bacteriological Techniques / Q000191:economics; D001938:Brazil / Q000453:epidemiology; D060085:Coinfection; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004185:Disability Evaluation; D016527:Drug Costs; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D007318:Inservice Training / Q000191:economics; D007538:Isoniazid / Q000191:economics* / Q000627:therapeutic use*; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D018803:Models, Economic; D011237:Predictive Value of Tests; D015397:Program Evaluation; D013902:Radiography, Thoracic / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014374:Tuberculin Test / Q000191:economics
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid