Cost-effectiveness of novel diagnostic tools for the diagnosis of tuberculosis

被引:0
|
作者
Dowdy, D. W. [1 ,2 ,3 ,4 ]
O'Brien, M. A. [6 ]
Bishai, D. [5 ]
机构
[1] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
[2] Johns Hopkins Univ, Sch Med, Baltimore, MD USA
[3] Johns Hopkins Univ, Ctr TB Res, Baltimore, MD USA
[4] Univ Calif San Francisco, Dept Med, San Francisco, CA USA
[5] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Populat Family & Reprod Hlth, Baltimore, MD USA
[6] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA
基金
美国国家卫生研究院;
关键词
tuberculosis; diagnostic techniques and procedures; costs and cost analysis; point-of-care systems; developing countries;
D O I
暂无
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
SETTING: The potential cost-effectiveness of Improved diagnostic tests for tuberculosis (TB) in resource-limited settings is unknown. OBJECTIVE: To estimate the incremental cost-effectiveness of a hypothetical new point-of-care TB diagnostic test in South Africa, Brazil and Kenya. DESIGN: Decision-analysis model, adding four diagnostic interventions (sputum smear microscopy, new test, smear plus new test and smear plus TB culture) to a baseline of existing infrastructure without smear. RESULTS: Adding sputum smear was estimated to be more cost-effective (incremental cost per disability-adjusted life year [DALY] of $86 [South Africa], $131 [Brazil], $38 (Kenya]) than a new TB diagnostic with 70% sensitivity, 95% specificity and price of $20 per test ($198 [South Africa], $275 [Brazil], $84 [Kenya]). However, compared to sputum smear, smear plus new test averted 46-49% more DALYs per 1000 TB suspects (321 vs. 215 [South Africa], 243 vs. 166 [Brazil], 790 vs. 531 [Kenya]), at an incremental cost of $170 (Kenya) to $625 (Brazil) per DALY averted. Cost-effectiveness was most sensitive to the specificity and price of the new test, the baseline TB case detection rate and the discount rite. CONCLUSION: Novel diagnostic tests for TB are potentially highly cost-effective. Cost-effectiveness is maximized by high-specificity, low-cost tests deployed to regions with poor infrastructure.
引用
收藏
页码:1021 / 1029
页数:9
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