title: Benefit of treatment of latent tuberculosis infection in individual patients.
abstract: We aimed to develop a decision aid that estimates whether treatment of latent tuberculosis infection (LTBI) is likely to have a net gain in quality-adjusted life-years for an individual. A Markov model was developed which incorporated personalised estimates for risk of tuberculosis (TB) reactivation, TB death, quality-of-life impairments and treatment side-effects. The net effect of LTBI treatment was quantified in terms of quality-adjusted life-years gained or lost. Analyses were conducted for a representative set of hypothetical patients. LTBI treatment was estimated to be beneficial when the annual risk of TB reactivation exceeded 13/100,000 to 93/100,000 for females aged 10-75 years and 15/100,000 to 119/100,000 for males aged 10-75 years; the numbers needed to treat to avoid one case of TB were 93, 77, 85 and 72, respectively, at these threshold levels. LTBI treatment was estimated to confer a positive net benefit across a broad range of patients with characteristics typically seen in a low incidence setting for TB. Use of the decision aid has the potential to facilitate and increase confidence with LTBI treatment decisions by providing clinicians and patients with personalised estimates of likely net benefit.
authors.affiliation: Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia South Western Sydney Clinical School, University of New South Wales Australia, Sydney, Australia cdobler@med.usyd.edu.au.
authors.forename: Claudia C
authors.identifier: http://orcid.org/0000-0002-5460-0189
authors.initials: CC
authors.lastname: Dobler
authors.affiliation: Clinical Trials Centre, University of Sydney, Sydney, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Martin
authors.affiliation: Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia South Western Sydney Clinical School, University of New South Wales Australia, Sydney, Australia.
authors.forename: Guy B
authors.initials: GB
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000401:mortality; D002648:Child; D005260:Female; D006505:Hepatitis / Q000401:mortality*; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects / Q000627:therapeutic use*; D055985:Latent Tuberculosis / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome; D014374:Tuberculin Test; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid