Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis

Abstract

BackgroundTuberculosis 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 co-morbidities 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.MethodsIn a public reference TB/HIV hospital in Brazil, we compared the cost-effectiveness of diagnostic strategies for diagnosis of pulmonary TB: Acid fast bacilli smear microscopy by Ziehl-Neelsen staining (AFB smear) plus culture and AFB smear plus colorimetric test (PCR dot-blot).From May 2003 to May 2004, sputum was collected consecutively from PTB suspects attending the Parthenon Reference Hospital. Sputum samples were examined by AFB smear, culture, and PCR dot-blot. The gold standard was a positive culture combined with the definition of clinical PTB. Cost analysis included health services and patient costs.ResultsThe AFB smear plus PCR dot-blot require the lowest laboratory investment for equipment (US$ 20,000). The total screening costs are 3.8 times for AFB smear plus culture versus for AFB smear plus PCR dot blot costs (US$ 5,635,760 versus US$ 1,498, 660). Costs per correctly diagnosed case were US$ 50,773 and US$ 13,749 for AFB smear plus culture and AFB smear plus PCR dot-blot, respectively. AFB smear plus PCR dot-blot was more cost-effective than AFB smear plus culture, when the cost of treating all correctly diagnosed cases was considered. The cost of returning patients, which are not treated due to a negative result, to the health service, was higher in AFB smear plus culture than for AFB smear plus PCR dot-blot, US$ 374,778,045 and US$ 110,849,055, respectively.ConclusionAFB smear associated with PCR dot-blot associated has the potential to be a cost-effective tool in the fight against PTB for patients attended in the TB/HIV reference hospital.

Impacto orçamentário da incorporação do GeneXpert MTB/RIF para o diagnóstico da tuberculose pulmonar na perspectiva do Sistema Único de Saúde, Brasil, 2013-2017

“…Nesse sentido, não é suficiente analisar o GeneXpert MTB/RIF somente através de análise de custo-efetividade, mas também como a eficácia, preconizada em ensaios clínicos como um desfecho fundamental na definição de diagnós-ticos, e a eficiência podem influenciar o impacto orçamentário da tecnologia para o PNCT. Ademais, cabe mencionar que há tecnologia disponível para a detecção da TB no Brasil além do Xpert MTB/ RIF e, embora não haja estimativa do impacto orçamentário, pressupõe que a oferta de outros testes também seja discutida para o controle da TB 31 .…”

HIV-associated tuberculous lymphadenitis: the importance of polymerase chain reaction (PCR) as a complementary tool for the diagnosis of tuberculosis - a study of 104 patients

“…The costs per correctly diagnosed case were around US$ 50 and US$ 13 for an acid-fast bacillus (AFB) smear plus culture and AFB smear plus PCR dot-blot, respectively. 13 Therefore, it is highly cost-effective to use PCR as routine practice in a hospital-based molecular pathology laboratory.…”

“…[9][10][11][12] In this regard, in-house conventional polymerase chain reaction (PCR) based on amplifying the IS6110 insertion element can be used to amplify Mycobacterium tuberculosis (MTB) DNA, offering the potential of a sensitive, specific and rapid diagnostic tool for either ruling out or considering pulmonary or extra pulmonary tuberculosis. [13][14][15] The present study was conducted in a hospital setting in the Amazonas Foundation of Tropical Medicine [Fundação de Medicina Tropical Amazonas (FMTAM)], where the incidence of both TB and HIV is high. A protocol was designed to investigate the effectiveness of combining PCR with histopathological examination, Ziehl-Neelsen staining and culture in Lowenstein-Jensen medium to diagnose TB using lymph node excisional biopsies.…”

Mycobacterium tuberculosis complex detected by modified fluorescent in situ hybridization in lymph nodes of clinical samples

“…Therefore, even if they are used in fixed samples, these characteristics make them a cost-effective tool in the fight against TB [24].…”