Clinical impact and cost analysis of the use of either the Xpert MTB Rif test or sputum smear microscopy in the diagnosis of pulmonary tuberculosis in Rio de Janeiro, Brazil

Castro, Analia Zuleika de; Moreira, A. R.; Oliveira, Jonice; Costa, Paulo Albuquerque da; Graça, Carolyne Lalucha Alves Lima Da; Pérez, Maurício de Andrade; Kritski, Afrânio Lineu; Vater, Maria Claudia

doi:10.1590/0037-8682-0082-2018

Cited by 10 publications

(4 citation statements)

References 15 publications

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“…Following the World Bank country classification for years 2021-2022 16 , data were collected for 2 High Income 33,34,42 , 2 Low Income 18, 21,28,29,32,38,39 , 5 Lower-middle Income 19,20,23,27,38 , and 3 Uppermiddle Income countries 22,[24][25][26]30,31,[35][36][37][38]40,41 (Table 1). Total Cost per rapid TB test ranged from $12.41 28 to $218 33 , reagents and consumable from $1.13 20 to $74.60 34 and equipment ranged from $0.40 25 to $14.34 34 .…”

Section: Systematic Review Of the Published Evidence On The Cost And ...mentioning

confidence: 99%

A systematic review of the costs of diagnosis for multidrug-resistant/extensively drug-resistant TB in different settings

Saderi

Cabibbe

Puci

et al. 2023

int j tuberc lung dis

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BACKGROUND: We performed an analysis of the cost and relative merits of different strategies for the diagnosis of multidrug-resistant/extensively drug-resistant TB (MDR/XDR-TB) in different settings.METHODS: We systematically reviewed the published evidence on cost/cost-effectiveness of rapid MDR/pre-XDR-TB and other methods for XDR-TB testing up to September 2022. PRISMA guidelines were followed. Collected data were analysed using Stata v17 software. Cost data were reported in USD ($) and summarised by mean, standard deviation, and range. Country income level was defined according to the World Bank country classification. Three simplified scenarios were also used to explore testing implications, based on low, intermediate and high TB incidence.RESULTS: Of 157 records, 25 studies were included with 24 reporting the cost of Xpert/RIF and two that evaluated the implementation of the MTBDRplus test. The total rapid test cost ranged from $12.41–$218, including $1.13–$74.60 for reagents/consumables and $0.40–$14.34 for equipment.CONCLUSION: The cost of MDR/XDR-TB diagnostics is lower in low resource settings. However, the cost-effective implementation of MDR/XDR-TB diagnostic algorithms requires careful consideration of local resources to avoid missed identification and the use of inappropriate regimen.

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Section: Systematic Review Of the Published Evidence On The Cost And ...mentioning

confidence: 99%

A systematic review of the costs of diagnosis for multidrug-resistant/extensively drug-resistant TB in different settings

Saderi

Cabibbe

Puci

et al. 2023

int j tuberc lung dis

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“…Respiratory samples were submitted to smear Ziehl-Nielsen staining technique, Xpert-MTB/RIF for Mtb, and sown in liquid culture BACTEC MGIT™ 960 and solid culture Löwenstein-Jensen. Xpert-MTB/RIF for Mtb, even being more expensive, was used as inclusion criterion because of its higher sensitivity [16].…”

Section: Study Proceduresmentioning

confidence: 99%

Safety and efficacy of N-acetylcysteine in hospitalized patients with HIV-associated tuberculosis: An open-label, randomized, phase II trial (RIPENACTB Study)

et al. 2020

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Despite the availability of effective antimicrobials, tuberculosis (TB) is still a serious health threat. Mortality is even higher in people living with HIV who are diagnosed with TB. New therapies are needed to shorten the time required to cure TB and decrease fatality rates in this population. N-acetylcysteine (NAC) is a glutathione precursor and has shown recently in experimental setting to present in vitro and in vivo anti-mycobacterial activity. We test the hypothesis that NAC is safe, well tolerated and secondarily efficacious as adjunctive anti-TB therapy in hospitalized individuals with HIV-associated TB. Patients were enrolled sequentially in a tertiary care center, in the Brazilian Amazon. We performed a randomized, parallel group, single-center, open study trial of two arms, in hospitalized patients over 18 years of age, with microbiologically confirmed pulmonary TB in HIV: one with rifampicin, isoniazid, pyrazinamide and ethambutol at standard doses (Control Group), and a second in which NAC 600 mg bid for eight weeks was added (NAC Group). A total of 21 and 18 patients were enrolled to the Control Group and NAC Group, respectively. Adverse event rates were similar in the two arms. Our findings suggest that in the more critical population of hospitalized patients with HIV-associated TB, the use of NAC was not unsafe, despite the low

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“…10,11 The Xpert MTB/RIF assay is a rapid (≤ 2hours) automated cartridge-based molecular test for the detection of Mycobacterium tuberculosis with its high sensitivity and specificity. [12][13][14] Currently, BAL Figure 1 shows the flow chart of the study…”

Section: Introductionmentioning

confidence: 99%

Role of Bronchoalveolar Lavage (BAL) Gene Xpert in Diagnosis of PTB in Sputum Smear Negative Patients

Alom¹,

Ali

Mahmud

et al. 2023

Comm. Based Med J

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The aim of this study was to assess the diagnostic efficacy of Xpert MTB/RIF assay in bronchoalveolar lavage (BAL) in the diagnosis of pulmonary tuberculosis in sputum-smear negative patients. This observational case series study was conducted in a tertiary base institute of Bangladesh from July 2017 to June 2019. All patients with suspected pulmonary tuberculosis who were sputum-smear negative, irrespective of age and gender were included in this study. BAL fluid thus obtained and examined the smear for acid fast bacilli (AFB) and Xpert MTB/RIF assay. The sensitivity, specificity and accuracy values were calculated for smear AFB and Xpert MTB/RIF assay. Xpert MTB/RIF was identified 33 (36.7%) of 90 patients on bronchoalveolar lavage fluid in the final analysis. AFB Fluid culture was positive in 28 (31.2%) cases. The sensitivity and specificity of Xpert MTB/RIF assay was 85.7%, and 85.5% respectively. The positive likelihood ratio was 5.90, and the negative likelihood ratio was 0.167. The accuracy was 85.56%. Xpert MTB/RIF on BAL fluid can be recommended as a fruitful diagnostic tool for mycobacterium pulmonary tuberculosis especially in sputum smear negative, and culture negative patients. CBMJ 2023 January: Vol. 12 No. 01 P: 60-66

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Clinical impact and cost analysis of the use of either the Xpert MTB Rif test or sputum smear microscopy in the diagnosis of pulmonary tuberculosis in Rio de Janeiro, Brazil

Cited by 10 publications

References 15 publications

A systematic review of the costs of diagnosis for multidrug-resistant/extensively drug-resistant TB in different settings

A systematic review of the costs of diagnosis for multidrug-resistant/extensively drug-resistant TB in different settings

Safety and efficacy of N-acetylcysteine in hospitalized patients with HIV-associated tuberculosis: An open-label, randomized, phase II trial (RIPENACTB Study)

Role of Bronchoalveolar Lavage (BAL) Gene Xpert in Diagnosis of PTB in Sputum Smear Negative Patients

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