Choice of preventive treatment for isoniazid-resistant tuberculous infection. Use of decision analysis and the Delphi technique

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Abstract
Proper care of persons infected with isoniazid-resistant tubercle bacilli is controversial because there are few data on the risks and benefits of the preventive treatment alternatives. Decision analysis was done to obtain estimates of relevant probabilities. Different strategies and the Delphi technique were compared. For all probabilities of isoniazid resistance, the observation and no-drug alternative is unsatisfactory because it would result in a 2-7-fold greater number of tuberculosis cases than any of the drug regimens. With a low probability of isoniazid resistance, isoniazid is the preventive treatment of least cost and proved efficacy. As the probability of isoniazid resistance increases, more cases are prevented by rifampin-containing regimens, but at added cost. These findings can be used to formulate appropriate, preventive treatment recommendations.

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