What Is the Cost of Preventing Tuberculosis a Cost-Effectiveness Analysis of Household Contact Tracing With 3HP Preventive Therapy in High-Burden Areas of Nepal?
Author(s)
Anchal Thapa, MSc1, Rajan Paudel, MSc1, Suvesh Shrestha, PhD2, Kunchok Dorjee, PhD3, Raghu Dhital, MA4, David W. Dowdy, PhD3, Maxine Caws, PhD5, Sourya Shrestha, PhD3.
1Research Department, Birat Nepal Medical Trust, Kathmandu, Nepal, 2University of Ottawa, Ottawa, ON, Canada, 3Johns Hopkins University, Baltimore, MD, USA, 4Birat Nepal Medical Trust, Kathmandu, Nepal, 5Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
1Research Department, Birat Nepal Medical Trust, Kathmandu, Nepal, 2University of Ottawa, Ottawa, ON, Canada, 3Johns Hopkins University, Baltimore, MD, USA, 4Birat Nepal Medical Trust, Kathmandu, Nepal, 5Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
OBJECTIVES: The WHO Southeast Asia Region, including Nepal, accounts for the highest global burden of latent TB infection (LTBI), with over 30% of the population estimated to be infected. This research aimed to estimate the costs and cost-effectiveness of the WHO-recommended 3 months of weekly rifapentine and isoniazid (3HP) in two high-burden districts (Pyuthan and Chitwan) of Nepal.
METHODS: Cost of implementation was calculated using an ingredients-based approach and reported separately for the two districts. We used an epidemiological transmission model to estimate disability-adjusted life years (DALYs) averted and incremental cost-effectiveness of household contact tracing with 3HP relative to no intervention. Cost-effectiveness was expressed as 2022 USD ($) per DALY averted from a healthcare perspective over a 20-year time horizon. Multivariate sensitivity analysis was performed to assess the sensitivity of cost-effectiveness estimates to uncertainties in model parameter values.
RESULTS: The cost of implementing household contact tracing with 3HP was $198 per person completing treatment in Pyuthan and $130 in Chitwan. The incremental cost-effectiveness of providing 3HP to household contacts (including the benefits of finding TB cases) was $132 (95% uncertainty interval: 69 - 265) per DALY averted overall: $149 (81-288) in Pyuthan and $115 (56 - 242) in Chitwan. The sensitivity analysis showed the most influential parameters were the proportion of household contacts with TB disease and the unit cost of the intervention per case.
CONCLUSIONS: Implementation of 3HP for latent TB infection management in high-burden districts of Nepal, such as Pyuthan and Chitwan, is cost-effective based on the country-specific WTP threshold of $38-$612. The findings support the scale-up of 3HP as feasible in the context of Nepal. Variation in implementation costs between districts highlights the importance of context-specific planning to optimize program efficiency and impact.
METHODS: Cost of implementation was calculated using an ingredients-based approach and reported separately for the two districts. We used an epidemiological transmission model to estimate disability-adjusted life years (DALYs) averted and incremental cost-effectiveness of household contact tracing with 3HP relative to no intervention. Cost-effectiveness was expressed as 2022 USD ($) per DALY averted from a healthcare perspective over a 20-year time horizon. Multivariate sensitivity analysis was performed to assess the sensitivity of cost-effectiveness estimates to uncertainties in model parameter values.
RESULTS: The cost of implementing household contact tracing with 3HP was $198 per person completing treatment in Pyuthan and $130 in Chitwan. The incremental cost-effectiveness of providing 3HP to household contacts (including the benefits of finding TB cases) was $132 (95% uncertainty interval: 69 - 265) per DALY averted overall: $149 (81-288) in Pyuthan and $115 (56 - 242) in Chitwan. The sensitivity analysis showed the most influential parameters were the proportion of household contacts with TB disease and the unit cost of the intervention per case.
CONCLUSIONS: Implementation of 3HP for latent TB infection management in high-burden districts of Nepal, such as Pyuthan and Chitwan, is cost-effective based on the country-specific WTP threshold of $38-$612. The findings support the scale-up of 3HP as feasible in the context of Nepal. Variation in implementation costs between districts highlights the importance of context-specific planning to optimize program efficiency and impact.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE753
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Medical Technologies
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas