Cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5–14 years in the Philippines
Background: Children aged 5–14 years who are household contacts (HHCs) of index people with active TB disease (PWTB) have limited coverage for TB preventive therapy (TPT) due to variable uptake of the national guideline recommendations in the Philippines. We conducted a cost-effectiveness analysis e...
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Elsevier
2025-05-01
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| Series: | Journal of Clinical Tuberculosis and Other Mycobacterial Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405579425000105 |
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| author | Ghassan Ilaiwy Jessica Keim-Malpass Romella Tuppal Alexander F. Ritua Flordeliza R. Bassiag Tania A. Thomas |
| author_facet | Ghassan Ilaiwy Jessica Keim-Malpass Romella Tuppal Alexander F. Ritua Flordeliza R. Bassiag Tania A. Thomas |
| author_sort | Ghassan Ilaiwy |
| collection | DOAJ |
| description | Background: Children aged 5–14 years who are household contacts (HHCs) of index people with active TB disease (PWTB) have limited coverage for TB preventive therapy (TPT) due to variable uptake of the national guideline recommendations in the Philippines. We conducted a cost-effectiveness analysis evaluating the expansion of TB infection (TBI) testing and treatment among pediatric (5–14 years) HHCs of index PWTB in the Philippines to assist the National TB program in choosing the most cost-effective testing and treatment strategy for TBI among HHCs of index PWTB. Methods: Using a Markov state transition model, eligible HHCs age 5–14 years are screened for TBI with either the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Those who test positive are then simulated to receive one of the following TPT strategies: 6 months of daily isoniazid (6H), 3 months of weekly isoniazid and rifapentine (3HP), 3 months of daily isoniazid plus rifampicin (3HR) and the current practice of no testing or treatment for TBI (NTT). The analysis assesses the projected cost and quality-adjusted life years (QALY) gained for every strategy from the perspective of the Philippines public healthcare system over a time horizon of 20 years. The total cost and gain in QALYs are presented as an incremental cost-effectiveness ratio (ICER) comparing cost per QALY gained for each strategy over NTT. Results: Our model estimates that expanding TPT coverage to HHCs aged 5–14 years would be cost-effective with incremental cost-effectiveness ratios (ICERs) ranging from 1,024 $/QALY gained when using TST and 6H (Uncertainty range: 497–––2,334) to 2,293 $/QALY gained when IGRA and 3HR are used (Uncertainty range: 1,140 – 5,203). These findings were robust to sensitivity analyses over a wide range of parameter values. Conclusion: Expanding TPT coverage to HHCs aged 5–14 years is cost-effective when using TST and 6H closely followed by a strategy combining TST and 3HP. |
| format | Article |
| id | doaj-art-5dcc3c02fab74ac395b1db3fec93fcfd |
| institution | OA Journals |
| issn | 2405-5794 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
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| series | Journal of Clinical Tuberculosis and Other Mycobacterial Diseases |
| spelling | doaj-art-5dcc3c02fab74ac395b1db3fec93fcfd2025-08-20T01:48:11ZengElsevierJournal of Clinical Tuberculosis and Other Mycobacterial Diseases2405-57942025-05-013910051910.1016/j.jctube.2025.100519Cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5–14 years in the PhilippinesGhassan Ilaiwy0Jessica Keim-Malpass1Romella Tuppal2Alexander F. Ritua3Flordeliza R. Bassiag4Tania A. Thomas5Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA; Corresponding author.School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA 22903, USACollege of Nursing, Isabela State University, PM7P+25G, 2nd Floor Admin Building, San Fabian, Echague, Isabela 3309, PhilippinesDepartment of Extension and Training, PM7P+25G, 2nd Floor Admin Building, San Fabian, Echague, Isabela 3309, PhilippinesDepartment of Research and Development, Isabela State University, PM7P+25G, 2nd Floor Admin Building, San Fabian, Echague, Isabela 3309, PhilippinesDepartment of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USABackground: Children aged 5–14 years who are household contacts (HHCs) of index people with active TB disease (PWTB) have limited coverage for TB preventive therapy (TPT) due to variable uptake of the national guideline recommendations in the Philippines. We conducted a cost-effectiveness analysis evaluating the expansion of TB infection (TBI) testing and treatment among pediatric (5–14 years) HHCs of index PWTB in the Philippines to assist the National TB program in choosing the most cost-effective testing and treatment strategy for TBI among HHCs of index PWTB. Methods: Using a Markov state transition model, eligible HHCs age 5–14 years are screened for TBI with either the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Those who test positive are then simulated to receive one of the following TPT strategies: 6 months of daily isoniazid (6H), 3 months of weekly isoniazid and rifapentine (3HP), 3 months of daily isoniazid plus rifampicin (3HR) and the current practice of no testing or treatment for TBI (NTT). The analysis assesses the projected cost and quality-adjusted life years (QALY) gained for every strategy from the perspective of the Philippines public healthcare system over a time horizon of 20 years. The total cost and gain in QALYs are presented as an incremental cost-effectiveness ratio (ICER) comparing cost per QALY gained for each strategy over NTT. Results: Our model estimates that expanding TPT coverage to HHCs aged 5–14 years would be cost-effective with incremental cost-effectiveness ratios (ICERs) ranging from 1,024 $/QALY gained when using TST and 6H (Uncertainty range: 497–––2,334) to 2,293 $/QALY gained when IGRA and 3HR are used (Uncertainty range: 1,140 – 5,203). These findings were robust to sensitivity analyses over a wide range of parameter values. Conclusion: Expanding TPT coverage to HHCs aged 5–14 years is cost-effective when using TST and 6H closely followed by a strategy combining TST and 3HP.http://www.sciencedirect.com/science/article/pii/S2405579425000105TuberculosisPediatric TBTB prevention |
| spellingShingle | Ghassan Ilaiwy Jessica Keim-Malpass Romella Tuppal Alexander F. Ritua Flordeliza R. Bassiag Tania A. Thomas Cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5–14 years in the Philippines Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Tuberculosis Pediatric TB TB prevention |
| title | Cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5–14 years in the Philippines |
| title_full | Cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5–14 years in the Philippines |
| title_fullStr | Cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5–14 years in the Philippines |
| title_full_unstemmed | Cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5–14 years in the Philippines |
| title_short | Cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5–14 years in the Philippines |
| title_sort | cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5 14 years in the philippines |
| topic | Tuberculosis Pediatric TB TB prevention |
| url | http://www.sciencedirect.com/science/article/pii/S2405579425000105 |
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