Study Model and Parameters
TB, infection, sepsis
INFECTION, SEPSIS
We constructed three distinct decision-analysis models to assess the cost-effectiveness of immediate empiric anti-TB treatment versus diagnosis-dependent standard of care using the three different TB diagnostic approaches (urine TB-LAM, sputum Xpert MTB/RIF, and LAM/Xpert) (Underlying TB prevalence rates in persons with HIV, treatment success and failure rates, and the sensitivity/specificity of urine TB-LAM, Xpert MTB/RIF, and LAM/Xpert are found in Mortality and disability weights (quality adjusted life years, or QALYs) associated with TB/HIV infection, TB treatment, HIV without TB, and sepsis were obtained from the extant literature and applied to the decision tree (We performed a one-way sensitivity analysis on key parameters by varying each parameter over a range of possible values that were supported by the literature to estimate the effects of parameter uncertainly on the decision analytic cases. In one-way sensitivity analysis, variables were entered into the model with varying estimates based either on known parameter ranges or outcomes greater/less than 10% of the original parameter estimates when a range was not available. We calculated incremental cost effectiveness ratios (ICER) by calculating the differences in costs between early anti-TB treatment and standard care (C1-C0) divided by the differences in effectiveness between early anti-TB treatment and standard care (E1-E0). We conducted the cost effectiveness analysis using TreeAge Pro 2023 R1 software (Williamstown, MA, USA). Institutional review was not required because this is not deemed human subjects research due to the mathematical modeling with parameter estimates obtained from existing published literature.