Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis
<p>Abstract</p> <p>Background</p> <p>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 co-morbidities such as Human Immunodeficiency Virus (HIV) infec...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2009-12-01
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| Series: | BMC Infectious Diseases |
| Online Access: | http://www.biomedcentral.com/1471-2334/9/216 |
| _version_ | 1819181070779678720 |
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| author | Vater Claudia Rossetti Maria LR Ruffino-Netto Antonio Sperhacke Rosa D Scherer Luciene C Klatser Paul Kritski Afrânio L |
| author_facet | Vater Claudia Rossetti Maria LR Ruffino-Netto Antonio Sperhacke Rosa D Scherer Luciene C Klatser Paul Kritski Afrânio L |
| author_sort | Vater Claudia |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>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 co-morbidities such as Human Immunodeficiency Virus (HIV) infection. Direct microscopy has low sensitivity and culture takes 3 to 6 weeks <abbrgrp><abbr bid="B1">1</abbr><abbr bid="B2">2</abbr><abbr bid="B3">3</abbr></abbrgrp>. Therefore, new tools for TB diagnosis are necessary, especially in health settings with a high prevalence of HIV/TB co-infection.</p> <p>Methods</p> <p>In 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).</p> <p>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.</p> <p>Results</p> <p>The 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.</p> <p>Conclusion</p> <p>AFB 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.</p> |
| first_indexed | 2024-12-22T22:24:24Z |
| format | Article |
| id | doaj.art-ee621e7e9ada4e9fa04bc94a65cb0afe |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-22T22:24:24Z |
| publishDate | 2009-12-01 |
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| series | BMC Infectious Diseases |
| spelling | doaj.art-ee621e7e9ada4e9fa04bc94a65cb0afe2022-12-21T18:10:35ZengBMCBMC Infectious Diseases1471-23342009-12-019121610.1186/1471-2334-9-216Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosisVater ClaudiaRossetti Maria LRRuffino-Netto AntonioSperhacke Rosa DScherer Luciene CKlatser PaulKritski Afrânio L<p>Abstract</p> <p>Background</p> <p>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 co-morbidities such as Human Immunodeficiency Virus (HIV) infection. Direct microscopy has low sensitivity and culture takes 3 to 6 weeks <abbrgrp><abbr bid="B1">1</abbr><abbr bid="B2">2</abbr><abbr bid="B3">3</abbr></abbrgrp>. Therefore, new tools for TB diagnosis are necessary, especially in health settings with a high prevalence of HIV/TB co-infection.</p> <p>Methods</p> <p>In 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).</p> <p>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.</p> <p>Results</p> <p>The 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.</p> <p>Conclusion</p> <p>AFB 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.</p>http://www.biomedcentral.com/1471-2334/9/216 |
| spellingShingle | Vater Claudia Rossetti Maria LR Ruffino-Netto Antonio Sperhacke Rosa D Scherer Luciene C Klatser Paul Kritski Afrânio L Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis BMC Infectious Diseases |
| title | Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis |
| title_full | Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis |
| title_fullStr | Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis |
| title_full_unstemmed | Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis |
| title_short | Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis |
| title_sort | cost effectiveness analysis of pcr for the rapid diagnosis of pulmonary tuberculosis |
| url | http://www.biomedcentral.com/1471-2334/9/216 |
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