Evaluation of the Mean Cost and Activity Based Cost in the Diagnosis of Pulmonary Tuberculosis in the Laboratory Routine of a High-Complexity Hospital in Brazil (original) (raw)
Related papers
Jornal Brasileiro de Pneumologia, 2015
We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF) and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System). In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smear microscopy were consumables/reagents and staff, respectively. These results might facilitate future cost-effectiveness studies and inform the decision-making process regarding the expansion of Xpert MTB/RIF use in Brazil.
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...
Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis
BMC Infectious Diseases, 2009
Background: Tuberculosis is one of the most prominent health problems in the world, causing 1.75 million deaths each year. Rapid clinical diagnosis is important in patients who have comorbidities such as Human Immunodeficiency Virus (HIV) infection. Direct microscopy has low sensitivity and culture takes 3 to 6 weeks [1-3]. Therefore, new tools for TB diagnosis are necessary, especially in health settings with a high prevalence of HIV/TB co-infection.
TB diagnostic tests: how do we figure out their costs?
Expert Review of Anti-infective Therapy, 2009
Tuberculosis continues to be a major global health problem. Lack of accurate, rapid and costeffective diagnostic tests poses a huge obstacle to global TB control. While several new diagnostic tools are being developed and evaluated for TB, it is important that new tools are introduced for widespread use only after careful validation of accuracy, impact as well as costeffectiveness in real-world settings. While there are large numbers of studies on the accuracy of TB diagnostic tests, there are few studies that are focused on cost and cost-effectiveness. There are currently no widely accepted standards on how to evaluate costs of a TB test. In this review, we describe the basic approach for computing the costs of TB diagnostic tests, and provide templates for various data elements and parameters that go into the costing ana lysis. We hope this will pave the way for a standardized methodology for costing of TB diagnostic tests. Such a tool would enable improved and more generalizable costing analyses that can provide a strong foundation for more sophisticated economic analyses that evaluate the full economic and epidemiological impact resulting from the implementation and routine use of performance-verified new and innovative diagnostic tools. This, in turn, will facilitate evidence-based adoption and use of new diagnostics, especially in resource-limited settings.
Cost analysis of rapid diagnostics for drug-resistant tuberculosis
BMC infectious diseases, 2018
Growth-based drug susceptibility testing (DST) is the reference standard for diagnosing drug-resistant tuberculosis (TB), but standard time to result (TTR) is typically ≥ 3 weeks. Rapid tests can reduce that TTR to days or hours, but accuracy may be lowered. In addition to the TTR and test accuracy, the cost of a diagnostic test may affect whether it is adopted in clinical settings. We examine the cost-effectiveness of rapid diagnostics for extremely drug-resistant TB (XDR-TB) in three different high-prevalence settings. 1128 patients with confirmed TB were enrolled at clinics in Mumbai, India; Chisinau, Moldova; and Port Elizabeth, South Africa. Patient sputum samples underwent DST for first and second line TB drugs using 2 growth-based (MGIT, MODS) and 2 molecular (Pyrosequencing [PSQ], line-probe assays [LPA]) assays. TTR was the primary measure of effectiveness. Sensitivity and specificity were also evaluated. The cost to perform each test at each site was recorded and included ...
D96. WHAT'S NEW IN TUBERCULOSIS DIAGNOSTICS, 2012
Background: Respiratory isolation of inpatients during evaluation for TB is a slow and costly process in low-burden settings. Xpert MTB/RIF (Xpert) is a novel molecular test for tuberculosis (TB) that is faster and more sensitive but substantially more expensive than smear microscopy. No previous studies have examined the costs of molecular testing as a replacement for smear microscopy in this setting.
BMC Infectious Diseases, 2013
Background: The World Health Organization has endorsed the use of molecular methods for the detection of TB and drug-resistant TB as a rapid alternative to culture-based systems. In South Africa, the Xpert MTB/Rif assay and the GenoType MTBDRplus have been implemented into reference laboratories for diagnosis of TB and drug-resistance, but their costs have not been fully elucidated. Methods: We conducted a detailed reference laboratory cost analysis of new rapid molecular assays (Xpert and MTBDRplus) for tuberculosis testing and drug-resistance testing in South Africa, and compared with the costs of conventional approaches involving sputum microscopy, liquid mycobacterial culture, and phenotypic drug sensitivity testing.
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.
Pulmonology, 2021
Introduction and objectives: Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST followed by IGRA to IGRA-only testing in 2016. Our objective was to compare the costeffectiveness of two-step TST/IGRA with the current IGRA-only screening strategy in immunocompetent individuals exposed to individuals with respiratory TB. Materials and Methods: We reviewed clinical records of individuals exposed to infectious TB cases diagnosed in 2015 and 2016, in two TB outpatient centers in the district of Porto. We estimated medical, non-medical and indirect costs for each screening strategy, taking into account costs of tests and health care personnel, travel distance from place of residence to screening site and employment status. We calculated the incremental cost-effectiveness ratio (ICER) as