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A Decision Analysis

Theresa J. Jordan, PhD; Eugene M. Lewit, PhD; Richard L. Montgomery, DDS, MPH; Lee B. Reichman, MD, MPH

JAMA. 1991;265(22):2987-2991.

Abstract
Tuberculin skin testing is a notoriously poor marker of tuberculosis infection in patients who are serologically positive for the human immunodeficiency virus. A decision analysis was performed to determine if and when isoniazid should be prescribed to prevent tuberculosis in these patients. The decision was analyzed for an intravenous drug abuser who may have been anergic, while tuberculin test status, race, and gender were varied. The assumptions and parameter estimates selected for this investigation represent a highly conservative vantage point opposing the use of isoniazid as a preventive therapy. Nevertheless, results showed a benefit from the use of isoniazid as a preventive therapy for all groups, even without tuberculin testing, except tuberculin-negative black women. This benefit of isoniazid therapy increased patient life expectancy as much as 285 days. Further, the decisions continue to favor prescribing isoniazid even when the suspected incidence of tuberculosis infection falls as low as 3% to 8%. Tuberculin testing appears important primarily for black women, since those who have negative tuberculin skin tests may not be candidates for isoniazid therapy.

(JAMA. 1991;265:2987-2991)

Author Affiliations
From the Division of Informatics (Drs Jordan and Montgomery), Department of Medicine (Dr Lewit), and Division of Pulmonary Medicine (Dr Reichman), University of Medicine & Dentistry of New Jersey, New Jersey Medical School, Newark. Dr Lewit is currently affiliated with the David and Lucile Packard Foundation, The Center for the Future of Children, Los Altos, Calif.

Footnotes
Reprint requests to Division of Pulmonary Medicine, University of Medicine & Dentistry of New Jersey, New Jersey Medical School, 150 Bergen St, I-354, Newark, NJ 07103-2406 (Dr Reichman).

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