• Kogieleum Naidoo, Anneke C Grobler, Nicola Deghaye, Tarylee Reddy, Santhanalakshmi Gengiah, Andrew Gray, and Abdool Karim Salim S.
• *Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; †Health Economics and HIV & AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa; ‡Biostatistics Unit, Medical Research Council, Durban, South Africa; §Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa; and ‖Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
• J. Acquir. Immune Defic. Syndr. 2015 Aug 15; 69 (5): 576-84.

ObjectiveInitiation of antiretroviral therapy (ART) during tuberculosis (TB) treatment improves survival in TB-HIV coinfected patients. In patients with CD4 counts <50 cells per cubic millimeter, there is a substantial clinical and survival benefit of early ART initiation. The purpose of this study was to assess the costs and cost-effectiveness of starting ART at various time points during TB treatment in patients with CD4 counts ≥50 cells per cubic millimeter.MethodsIn the SAPiT trial, 642 HIV-TB coinfected patients were randomized to 3 arms: receiving ART within 4 weeks of starting TB treatment (early treatment arm; Arm-1), after the intensive phase of TB treatment (late treatment arm; Arm-2), or after completing TB treatment (sequential arm; Arm-3). Direct health care costs were measured from a provider perspective using a micro-costing approach. The incremental cost per death averted was calculated using the trial outcomes.ResultsFor patients with CD4 count ≥50 cells per cubic millimeter, median monthly variable costs per patient were US $116, US $113, and US $102 in Arm-1, Arm-2 and Arm-3, respectively. There were 12 deaths in 177 patients in Arm-1, 8 deaths in 180 patients in the Arm-2, and 19 deaths in 172 patients in Arm-3. Although the costs were lower in Arm-3, it had a substantially higher mortality rate. The incremental cost per death averted associated with moving from Arm-3 to Arm-2 was US $4199. There was no difference in mortality between Arm-1 and Arm-2, but Arm-1 was slightly more expensive.ConclusionsInitiation of ART after the completion of the intensive phase of TB treatment is cost-effective for patients with CD4 counts ≥50 cells per cubic millimeter.

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