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. @ERSpublications Personalised analysis showed that most people with latent tuberculosis infection benefit from preventive treatment

Preventive therapy for latent tuberculosis infection—the promise and the challenges

“…Decision analysis modelling has shown that the vast majority of immunocompromised patients with LTBI will benefit from LTBI treatment. 21,97 However, the decision to screen those with immunosuppressive conditions must consider a range of additional factors. The true incidence of LTBI in the specific population, and the accuracy of LTBI tests (especially the proportion of false-negative results of TSTs and IGRAs) will have a major impact on the costs and benefits of a screening programme.…”

Diagnosis and management of latent tuberculosis

“…Individuals at risk for new infection include recent immigrants from high incidence countries and close contacts of patients with active tuberculosis disease (particularly young children or the elderly) whereas individuals at increased risk of reactivation include those with HIV, other immunosuppressing conditions (including tumor necrosis factor-a inhibitors, hematologic or solid organ malignancies, organ transplant, chemotherapy), and those with evidence of fibronodular imaging changes suggestive of healed tuberculosis [5]. Various studies suggest that a targeted testing and treatment plan is cost effective and provides both population and individual benefit for at least several of these high-risk groups [32][33][34]. Prior to treatment for LTBI, it is imperative to exclude active disease.…”

Benefit of treatment of latent tuberculosis infection in individual patients

“…In their recent article, D obler et al [1] described a decision aid that estimates a net benefit of treatment for latent tuberculosis infection (LTBI) in a low tuberculosis incidence environment. While the aid probably confers some clinical utility as described, its dynamic robustness could be strengthened in some important respects.…”