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- Publisher Website: 10.1371/journal.pone.0004057
- Scopus: eid_2-s2.0-58149186469
- PMID: 19129940
- WOS: WOS:000265466000017
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Article: Impact and cost-effectiveness of culture for diagnosis of tuberculosis in HIV-infected Brazilian adults
Title | Impact and cost-effectiveness of culture for diagnosis of tuberculosis in HIV-infected Brazilian adults |
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Authors | |
Issue Date | 2008 |
Citation | PLoS ONE, 2008, v. 3, n. 12, article no. e4057 How to Cite? |
Abstract | Background: Culture of Mycobacterium tuberculosis currently represents the closest "gold standard" for diagnosis of tuberculosis (TB), but operational data are scant on the impact and cost-effectiveness of TB culture for human immunodeficiency (HIV-) infected individuals in resource-limited settings. Methodology/Principal Findings: We recorded costs, laboratory results, and dates of initiating TB therapy in a centralized TB culture program for HIV-infected patients in Rio de Janeiro, Brazil, constructing a decision-analysis model to estimate the incremental cost-effectiveness of TB culture from the perspective of a public-sector TB control program. Of 217 TB suspects presenting between January 2006 and March 2008, 33 (15%) had culture-confirmed active tuberculosis; 23 (70%) were smear-negative. Among smear-negative, culture-positive patients, 6 (26%) began TB therapy before culture results were available, 11 (48%) began TB therapy after culture result availability, and 6 (26%) did not begin TB therapy within 180 days of presentation. The cost per negative culture was US$17.52 (solid media)-$23.50 (liquid media). Per 1,000 TB suspects and compared with smear alone, TB culture with solid media would avert an estimated eight TB deaths (95% simulation interval [SI]: 4, 15) and 37 disability-adjusted life years (DALYs) (95% SI: 13, 76), at a cost of $36 (95% SI: $25, $50) per TB suspect or $962 (95% SI: $469, $2642) per DALY averted. Replacing solid media with automated liquid culture would avert one further death (95% SI: 21, 4) and eight DALYs (95% SI: 24, 23) at $2751 per DALY (95% SI: $680, dominated). The cost-effectiveness of TB culture was more sensitive to characteristics of the existing TB diagnostic system than to the accuracy or cost of TB culture. Conclusions/Significance: TB culture is potentially effective and cost-effective for HIV-positive patients in resource-constrained settings. Reliable transmission of culture results to patients and integration with existing systems are essential. © 2008 Dowdy et al. |
Persistent Identifier | http://hdl.handle.net/10722/326762 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Dowdy, David W. | - |
dc.contributor.author | Lourenço, Maria C. | - |
dc.contributor.author | Cavalcante, Solange C. | - |
dc.contributor.author | Saraceni, Valeria | - |
dc.contributor.author | King, Bonnie | - |
dc.contributor.author | Golub, Jonathan E. | - |
dc.contributor.author | Bishai, David | - |
dc.contributor.author | Durovni, Betina | - |
dc.contributor.author | Chaisson, Richard E. | - |
dc.contributor.author | Dorman, Susan E. | - |
dc.date.accessioned | 2023-03-31T05:26:20Z | - |
dc.date.available | 2023-03-31T05:26:20Z | - |
dc.date.issued | 2008 | - |
dc.identifier.citation | PLoS ONE, 2008, v. 3, n. 12, article no. e4057 | - |
dc.identifier.uri | http://hdl.handle.net/10722/326762 | - |
dc.description.abstract | Background: Culture of Mycobacterium tuberculosis currently represents the closest "gold standard" for diagnosis of tuberculosis (TB), but operational data are scant on the impact and cost-effectiveness of TB culture for human immunodeficiency (HIV-) infected individuals in resource-limited settings. Methodology/Principal Findings: We recorded costs, laboratory results, and dates of initiating TB therapy in a centralized TB culture program for HIV-infected patients in Rio de Janeiro, Brazil, constructing a decision-analysis model to estimate the incremental cost-effectiveness of TB culture from the perspective of a public-sector TB control program. Of 217 TB suspects presenting between January 2006 and March 2008, 33 (15%) had culture-confirmed active tuberculosis; 23 (70%) were smear-negative. Among smear-negative, culture-positive patients, 6 (26%) began TB therapy before culture results were available, 11 (48%) began TB therapy after culture result availability, and 6 (26%) did not begin TB therapy within 180 days of presentation. The cost per negative culture was US$17.52 (solid media)-$23.50 (liquid media). Per 1,000 TB suspects and compared with smear alone, TB culture with solid media would avert an estimated eight TB deaths (95% simulation interval [SI]: 4, 15) and 37 disability-adjusted life years (DALYs) (95% SI: 13, 76), at a cost of $36 (95% SI: $25, $50) per TB suspect or $962 (95% SI: $469, $2642) per DALY averted. Replacing solid media with automated liquid culture would avert one further death (95% SI: 21, 4) and eight DALYs (95% SI: 24, 23) at $2751 per DALY (95% SI: $680, dominated). The cost-effectiveness of TB culture was more sensitive to characteristics of the existing TB diagnostic system than to the accuracy or cost of TB culture. Conclusions/Significance: TB culture is potentially effective and cost-effective for HIV-positive patients in resource-constrained settings. Reliable transmission of culture results to patients and integration with existing systems are essential. © 2008 Dowdy et al. | - |
dc.language | eng | - |
dc.relation.ispartof | PLoS ONE | - |
dc.title | Impact and cost-effectiveness of culture for diagnosis of tuberculosis in HIV-infected Brazilian adults | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1371/journal.pone.0004057 | - |
dc.identifier.pmid | 19129940 | - |
dc.identifier.scopus | eid_2-s2.0-58149186469 | - |
dc.identifier.volume | 3 | - |
dc.identifier.issue | 12 | - |
dc.identifier.spage | article no. e4057 | - |
dc.identifier.epage | article no. e4057 | - |
dc.identifier.eissn | 1932-6203 | - |
dc.identifier.isi | WOS:000265466000017 | - |