COST-EFFECTIVENESS AND TOTAL COSTS OF 3 ALTERNATIVE STRATEGIES FOR THE PREVENTION AND MANAGEMENT OF SEVERE SKIN REACTIONS ATTRIBUTABLE TO THIACETAZONE IN THE TREATMENT OF HUMAN-IMMUNODEFICIENCY-VIRUS POSITIVE PATIENTS WITH TUBERCULOSIS IN KENYA

Setting: Severe skin reactions due to thiacetazone (T) in Human Immuno deficiency Virus (HIV) positive tuberculosis patients have been report ed in several publications, one of them from Kenya. However, the aband oning of T may not be feasible in Kenya as this may increase the cost of drugs by about threefold per regimen. Objective: To compare the cos t-effectiveness and total cost of three strategies in which T is repla ced with ethambutol (E). Design: Three strategies are compared with a baseline strategy in which T is not replaced. The indicator for cost-e ffectiveness is the cost-per-averted-death attributable to T. Results: Education of patients on the possibility of side-effects and replacem ent of T with E is the most cost-effective strategy at HIV prevalence rates of 1-90%. Abandonment of T and replacement with E is the most co st-effective at over 90% HIV prevalence. Conclusion: In Kenya, educati on of patients on the possibility of skin reactions should be preferre d at low range HIV prevalence rates. Routine HIV testing would be the most attractive strategy in the middle range, and total replacement of T with E is to be preferred in the higher range of HIV prevalence.