N Yakhelef1, M Audibert1, F Varaine2, J Chakaya3, J Sitienei4, H Huerga5, M Bonnet5. 1. Centre d'Etudes et de Recherches sur le Développement International, Centre National de la Recherche Scientifique, Université d'Auvergne, Clermont-Ferrand, France. 2. Médecins Sans Frontières, Paris, France. 3. Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya. 4. National Leprosy and TB Control Programme, Nairobi, Kenya. 5. Epicentre, Paris, France.
Abstract
SETTING: In 2007, the World Health Organization recommended introducing rapid Mycobacterium tuberculosis culture into the diagnostic algorithm of smear-negative pulmonary tuberculosis (TB). OBJECTIVE: To assess the cost-effectiveness of introducing a rapid non-commercial culture method (thin-layer agar), together with Löwenstein-Jensen culture to diagnose smear-negative TB at a district hospital in Kenya. DESIGN: Outcomes (number of true TB cases treated) were obtained from a prospective study evaluating the effectiveness of a clinical and radiological algorithm (conventional) against the alternative algorithm (conventional plus M. tuberculosis culture) in 380 smear-negative TB suspects. The costs of implementing each algorithm were calculated using a 'micro-costing' or 'ingredient-based' method. We then compared the cost and effectiveness of conventional vs. culture-based algorithms and estimated the incremental cost-effectiveness ratio. RESULTS: The costs of conventional and culture-based algorithms per smear-negative TB suspect were respectively €39.5 and €144. The costs per confirmed and treated TB case were respectively €452 and €913. The culture-based algorithm led to diagnosis and treatment of 27 more cases for an additional cost of €1477 per case. CONCLUSION: Despite the increase in patients started on treatment thanks to culture, the relatively high cost of a culture-based algorithm will make it difficult for resource-limited countries to afford.
SETTING: In 2007, the World Health Organization recommended introducing rapid Mycobacterium tuberculosis culture into the diagnostic algorithm of smear-negative pulmonary tuberculosis (TB). OBJECTIVE: To assess the cost-effectiveness of introducing a rapid non-commercial culture method (thin-layer agar), together with Löwenstein-Jensen culture to diagnose smear-negative TB at a district hospital in Kenya. DESIGN: Outcomes (number of true TB cases treated) were obtained from a prospective study evaluating the effectiveness of a clinical and radiological algorithm (conventional) against the alternative algorithm (conventional plus M. tuberculosis culture) in 380 smear-negative TB suspects. The costs of implementing each algorithm were calculated using a 'micro-costing' or 'ingredient-based' method. We then compared the cost and effectiveness of conventional vs. culture-based algorithms and estimated the incremental cost-effectiveness ratio. RESULTS: The costs of conventional and culture-based algorithms per smear-negative TB suspect were respectively €39.5 and €144. The costs per confirmed and treated TB case were respectively €452 and €913. The culture-based algorithm led to diagnosis and treatment of 27 more cases for an additional cost of €1477 per case. CONCLUSION: Despite the increase in patients started on treatment thanks to culture, the relatively high cost of a culture-based algorithm will make it difficult for resource-limited countries to afford.
Authors: Alice L den Hertog; María Montero-Martín; Rachel L Saunders; Matthew Blakiston; Sandra Menting; Jeevan B Sherchand; Lovett Lawson; Olanrewaju Oladimeji; Saddiq T Abdurrahman; Luis E Cuevas; Richard M Anthony Journal: PLoS One Date: 2015-06-26 Impact factor: 3.240
Authors: Nadia Yakhelef; Martine Audibert; Gabriella Ferlazzo; Joseph Sitienei; Steve Wanjala; Francis Varaine; Maryline Bonnet; Helena Huerga Journal: PLoS One Date: 2020-01-30 Impact factor: 3.240
Authors: David Patrick Kateete; Adrian Muwonge; Monica M Mbabazi; Faith Nakazzi; Fred A Katabazi; Edgar Kigozi; Willy Ssengooba; Lydia Nakiyingi; Sharon Namiiro; Alphonse Okwera; Moses L Joloba Journal: Sci Rep Date: 2021-12-29 Impact factor: 4.379
Authors: Simon van der Pol; Paula Rojas Garcia; Maarten J Postma; Fernando Antoñanzas Villar; Antoinette D I van Asselt Journal: Pharmacoeconomics Date: 2021-07-15 Impact factor: 4.981