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Exposure to tuberculosis among newborns in a nursery: decision analysis for initiation of prophylaxis [Article de Revue]

[Exposition à la tuberculose dans une nurserie : analyse décisionnelle pour une mise en route de la prophylaxie]
Infection control and hospital epidemiology. 2006/06; 27(6) : 604-611
Summary: OBJECTIVE. Newborns in a hospital nursery were exposed to a mother whose sputum was direct-smear negative for acid-fast bacilli but culture positive for Mycobacterium tuberculosis. Given the low risk for exposure, the high susceptibility of infants to M. tuberculosis infection, and the possibility of hepatotoxicity due to isoniazid therapy, a decision analysis model was used to determine whether administration of isoniazid prophylaxis against tuberculosis is preferable to no administration of prophylaxis.DESIGN. A decision analysis tree was constructed with software, using probabilities from the literature and costs from local health facilities. The expected values for each strategy were obtained, and sensitivity analyses were performed.RESULTS. For the strategy in which prophylaxis was administered under direct observation (DO), the probability for survival was 0.999980. For the strategy in which no prophylaxis was administered, the probability of survival was 0.999950, which corresponds to 3 more deaths per 100,000 patients than with the DO prophylaxis strategy. The incremental cost-effectiveness of the DO prophylaxis strategy was $21,710,000 per death prevented. Sensitivity analysis for survival showed that the DO prophylaxis strategy was preferable to the strategy in which no prophylaxis is given if the probability of infection was >0.0002, the probability of tuberculous disease in an infected infant who did not receive prophylaxis was greater than 0.12, the probability of dying from tuberculosis was greater than 0.025, the probability of hepatotoxicity was less than 0.004, and the probability of dying from hepatotoxicity was less than 0.04. For the strategy in which prophylaxis was administered under non-DO conditions (ie, by parents), the incremental cost-effectiveness was $929,500 per death prevented, which is approximately 5% of the incremental cost-effectiveness of the DO prophylaxis strategy.CONCLUSION. This model provides a structure for determining the preferable prophylaxis strategies for different risks of exposure to tuberculosis in a nursery. Administration of prophylaxis is preferable to no administration of prophylaxis, unless the probability of infection is extremely low.(RESUME D'AUTEUR)



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CClin Est
CHU de Nancy - Hôpitaux de Brabois
Rue du Morvan
54511 Vandoeuvre le Nancy Cedex
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CClin Ouest
CHU Hôtel Dieu
CS 26419
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CCLIN Paris Nord
CClin Paris-Nord
96 rue Didot
75014 Paris
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Hospices Civils de Lyon
Hôpital Henry Gabriel
20 route de vourles
69230 Saint-Genis-Laval
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CCLIN Sud-Ouest
CClin Sud-Ouest
CHU de Bordeaux
Hôpital Pellegrin - Bâtiment Le Tondu
33076 Bordeaux
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