Objective: To compare health outcomes and costs of different strategies for
treatment of latent tuberculosis infection in pregnancy.
Methods: Using a Markov decision-analysis model, the following three strate
gies were evaluated for treatment of latent tuberculosis infection in pregn
ancy, defined as positive tuberculin skin reaction of 10 mm or greater and
negative chest radiograph: no treatment, antepartum isoniazid administratio
n, in which women were given 300 mg of isoniazid with pyridoxine beginning
at 20 weeks' gestation for 6 months; and postpartum isoniazid, in which wom
en were given isoniazid and pyridoxine for 6 months after delivery. Sensiti
vity analyses were performed for a wide range of probability and cost estim
ates, and considered discount rates.
Results: Under base-case assumptions, the fewest cases of tuberculosis with
in the cohort occurred with antepartum treatment (1400 per 100,000) compare
d with no treatment (3300 per 100,000) or postpartum treatment (1800 per 10
0,000). Antepartum treatment resulted in a marginal increase in life expect
ancy due to the prevented cases of tuberculosis, despite more cases of ison
iazid-related hepatitis and deaths, compared with no treatment or postpartu
m treatment. Antepartum treatment was the least expensive. Only if the case
-fatality rate for tuberculosis was tenfold lower than the base-case and th
e risk of fatal hepatitis tenfold higher did antepartum treatment become th
e least advantageous strategy.
Conclusion: Rather than delaying treatment until postpartum, consideration
for antepartum treatment of latent tuberculosis during pregnancy should be
given. If isoniazid is not administered antepartum, then efforts to improve
postpartum compliance should be instituted, as either antepartum or postpa
rtum treatment is better than no treatment. (Obstet Gynecol 2000;96:757-62.
(C) 2000 by The American College of Obstetricians and Gynecologists.).