Costs and cost-effectiveness of tuberculosis cultures using solid and liquid media in a developing country (original) (raw)
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International Journal of Infectious Diseases, 2009
Objective: To evaluate the diagnostic performance of two liquid-phase culture media for the diagnosis of pulmonary tuberculosis. Patients and methods: From May to July 2003, sputum samples for culture were obtained from patients with respiratory symptoms attending the Hospital Nacional Cayetano Heredia. These were cultured in Ogawa medium, mycobacteria growth indicator tube (MGIT), and modified Middlebrook 7H9. Results were compared against a composite reference standard. Results: One hundred sputum specimens from 100 patients were included. Of these, 33 had culture-proven tuberculosis. The sensitivity of MGIT was found to be 100%. The modified Middlebrook 7H9 medium was found to have a sensitivity of 72.73%, while the sensitivity of Ogawa medium was found to be 69.70%. The mean growing time for MGITwas 12.18 days (95% confidence interval 10.24 to 14.12; p < 0.01 vs. Ogawa and modified Middlebrook 7H9); for modified Middlebrook 7H9 was 16.65 days (95% confidence interval 14.85 to 18.80; p < 0.01 vs. Ogawa), and for the Ogawa medium 25.74 days (95% confidence interval 22.22 to 29.6). Conclusions: The liquid culture medium MGIT was superior to the modified Middlebrook 7H9 and the Ogawa media, both in terms of sensitivity and shorter growing time of colonies of Mycobacterium tuberculosis. The modified Middlebrook 7H9 medium is significantly faster but comparable in diagnostic performance to Ogawa. Costs remain an issue for MGIT.
The International Journal of Tuberculosis and Lung Disease, 2014
In 2007, the World Health Organization recommended introducing rapid Mycobacterium tuberculosis culture into the diagnostic algorithm of smearnegative pulmonary tuberculosis (TB). O B J E C T I V E : To assess the cost-effectiveness of introducing a rapid non-commercial culture method (thinlayer agar), together with Löwenstein-Jensen culture to diagnose smear-negative TB at a district hospital in Kenya. D E S I G N : 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 smearnegative TB suspects. The costs of implementing each algorithm were calculated using a 'micro-costing' or 'ingredient-based' method. We then compared the cost
Cost-effectiveness in the diagnosis of tuberculosis: choices in developing countries
The Journal of Infection in Developing Countries, 2014
Tuberculosis remains one of the major causes of global death from a single infectious agent. This situation is worsened by the HIV/AIDS pandemic because one-third of HIV/AIDS patients are co-infected with Mycobacterium tuberculosis. Failure to control the spread of tuberculosis is largely due to our inability to detect and treat all infectious cases of pulmonary tuberculosis in a timely manner, allowing continued M. tuberculosis transmission within communities. Diagnosis of tuberculosis can be made using indirect and direct methods. The indirect tests, such as interferon-gamma release assays, provide a new diagnostic method for M. tuberculosis infection, but do not discriminate between infection and active disease. The most common direct method for diagnosing TB worldwide is sputum smear microscopy (developed more than 100 years ago), where bacteria are observed in sputum samples examined under a microscope. In countries with more developed laboratory capacities, cases of tuberculos...
PLOS ONE, 2015
Background The use of liquid medium (MGIT960) for tuberculosis (TB) diagnosis was recommended by WHO in 2007. However, there has been no evaluation of its effectiveness on clinically important outcomes. Methods and Findings A pragmatic trial was carried out in a tertiary hospital and a secondary health care unit in Rio de Janeiro City, Brazil. Participants were 16 years or older, suspected of having TB. They were excluded if only cerebral spinal fluid or blood specimens were available for analysis. MGIT960 technique was compared with the Lowenstein-Jensen (LJ) method for laboratory diagnosis of active TB. Primary outcome was the proportion of patients who had their initial medical management changed within 2 months after randomisation. Secondary outcomes were: mean time for changing the procedure, patient satisfaction with the overall treatment and adverse events. Data were analysed by intention-to-treat. Between April 2008 and September 2011, 693 patients were enrolled (348 to MGIT, 345 to LJ). Smear and culture results were positive for 10% and 15.7% of participants, respectively. Patients in the MGIT arm had their initial medical management changed more frequently than those in the LJ group (10.1% MGIT vs 3.8% LJ, RR 2.67 95% CI 1.44-.96, p = 0.002, NNT 16, 95% CI 10-39). Mean time for changing the initial procedure was greater in LJ group at both sites: 20.0
Value in Health, 2019
OBJECTIVES: Case detection is an important aspect of the TB control strategy recommended by the WHO. Case detection rate remains as low as 55% amidst increasing TB cases in urban centers. This study therefore aimed at determining the cost effectiveness of ACF and PCF in detecting TB cases. METHODS: This was a cross sectional study design from the provider’s perspective carried out between September 2018 and February 2019. Data on costs and yield of TB cases for PCF and ACF was collected among adults aged 15-49 years at Kisugu HC III located in highly-congested and urban setting in Kampala district, Uganda. Costs were adjusted to US$ for the 2015 annual average. Capital Assets were annualized. Incremental Cost Effectiveness Ratio (ICER) represented the cost to detect an additional TB case and decision threshold based on Uganda’s GDP (US$ 2089). One & two-way sensitivity analyses were done to assess uncertainty of the ICER around key variables. RESULTS: The unit cost of detecting a TB case was 8.14and8.14 and 8.14and7.01 under ACF and PCF respectively. After sensitivity analyses, ACF was not cost effective. ACF was less effective yet more costly in detecting TB cases who presented with chronic cough. PCF was more effective and less costly. The incremental cost of detecting an additional case of TB under ACF was $ 1.13 with an incremental effectiveness ratio of -0.41. CONCLUSIONS: In an African City context, ACF is not cost effective compared to PCF. ACF provided a less number of T.B cases detected yet it was more costly compared to PCF. Note that patients who present to the health facilities (with symptoms) have a high chance of having TB. Therefore, implementation of PCF as a part of the recommended TB control strategy should be prioritized. Other low cost strategies like Household Contact investigation need to be used in complementary.
PLOS ONE, 2020
Introduction Resource constraints in Low and Middle-Income Countries (LMICs) limit tuberculosis (TB) contact investigation despite evidence its benefits could outweigh costs, with increased efficiency when compared with intensified case finding (ICF). However, there is limited data on yield and cost per TB case identified. We compared yield and cost per TB case identified for ICF and Tuberculosis-Contact Investigation (TB-CI) in Uganda. Methods A retrospective cohort study based on data from 12 Ugandan hospitals was done between April and September 2017. Two methods of TB case finding (i.e. ICF and TB-CI) were compared. Regarding ICF, patients either self-reported their signs and symptoms or were prompted by health care workers, while TB-CI was done by home-visiting and screening contacts of TB patients. Patients who were presumed to have tuberculosis were requested to produce a sample for examination. TB yield was defined as a ratio of diagnoses to tests, and this was computed per method of diagnosis. The cost per TB case identified (medical, personnel, transportation and training) for each diagnosis method were computed using the activity-based approach, from the health care perspective. Cost data were analyzed using Windows Excel. Results 454 index TB cases and 2,707 of their household contacts were investigated. Thirty-one per cent of contacts (840/2707) were found to be presumptive TB cases.
Health research policy and systems / BioMed Central, 2015
Despite the recent innovations in tuberculosis (TB) and multi-drug resistant TB (MDR-TB) diagnosis, culture remains vital for difficult-to-diagnose patients, baseline and end-point determination for novel vaccines and drug trials. Herein, we share our experience of establishing a BSL-3 culture facility in Uganda as well as 3-years performance indicators and post-TB vaccine trials (pioneer) and funding experience of sustaining such a facility. Between September 2008 and April 2009, the laboratory was set-up with financial support from external partners. After an initial procedure validation phase in parallel with the National TB Reference Laboratory (NTRL) and legal approvals, the laboratory registered for external quality assessment (EQA) from the NTRL, WHO, National Health Laboratories Services (NHLS), and the College of American Pathologists (CAP). The laboratory also instituted a functional quality management system (QMS). Pioneer funding ended in 2012 and the laboratory remained...
Comparative Study of Solid Culture and Liquid Culture for the Diagnosis of Pulmonary Tuberculosis
Journal of Shaheed Suhrawardy Medical College
Background: Tuberculosis is a highly infectious disease and has the highest burden with it. Diagnosis of tuberculosis in many countries is still dependent on microscopy. For developing countries with a large number of cases and financial constraints, evaluation of rapid and inexpensive diagnostic methods has great importance. Culture of Mycobacterium tuberculosis complex (MtbC) is the accepted reference standard for confirmation of TB infection and is necessary for drug susceptibility testing (DST). There are several methods for culturing MtbC using solid and liquid media. Although solid media has been used for over 100 years, liquid culture media is increasingly being introduced in low and middle income countries (LMIC). Objective: The purpose of the present study was to compare the efficacy of solid culture and liquid culture in the diagnosis of pulmonary tuberculosis. Methodology: This cross sectional study was done in the Department of Microbiology at Sir Salimullah Medical Coll...