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CME Credit Offered
CME Credit Offered
Abstract Award
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Poster Session 2

(429) Cost-effectiveness of antepartum versus postpartum treatment of latent tuberculosis infection

Thursday, January 30, 2025
4:00 PM – 6:00 PM  
Objective: Treatment of latent tuberculosis infection (LTBI) during pregnancy is typically reserved for high-risk cases due to concerns about potential side effects. However, pregnancy provides a unique interaction with the healthcare system, offering an opportunity to treat LTBI and prevent future progression to active tuberculosis (TB). This study aimed to evaluate the health outcomes and cost-effectiveness of antepartum versus postpartum treatment among pregnant individuals with LTBI.

Study Design: A decision-analytic model using TreeAge software was constructed to compare the outcomes and cost-effectiveness of antepartum versus postpartum treatment of LTBI. The theoretical cohort included 20,000 individuals with LTBI based on the number of annual pregnancies and prevalence of LTBI in the United States. Outcomes included the number of complete treatments, drug-induced hepatotoxicity, progression to active TB, fatality from active TB, and cases of untreated latent TB based on data demonstrating lower adherence and follow-up in the postpartum period. Model inputs were derived from the literature. The threshold for cost-effectiveness was $100,000/ quality-adjusted life year (QALY). Sensitivity analyses were performed to assess the robustness of the results.

Results: Compared to postpartum treatment, the antepartum treatment strategy resulted in 4,217 additional treatment completions, 239 fewer cases of progression to active TB, and 17 fewer fatalities from active TB (Table 1). Additionally, the postpartum group had 4,520 cases of untreated LTBI related to the rate of lower follow-up postpartum. Antepartum treatment was the cost-effective and dominant strategy, resulting in cost savings of $8,555,587 and an increase in 4,266 QALYs relative to postpartum treatment.

Conclusion: The antepartum treatment strategy for LTBI was cost-effective and resulted in better health outcomes compared to postpartum treatment. These findings may inform future policies that integrate LTBI treatment into prenatal care to potentially improve outcomes and enhance resource allocation.