Cost-effectiveness of diagnostic algorithms including lateral-flow urine lipoarabinomannan for HIV-positive patients with symptoms of tuberculosis

Yakhelef, Nadia; Audibert, Martine; Ferlazzo, Gabriella; Sitienei, Joseph; Wanjala, Steve; Varaine, Francis; Bonnet, Maryline; Huerga, Helena

doi:10.1371/journal.pone.0227138

Cited by 7 publications

(4 citation statements)

References 25 publications

(36 reference statements)

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“…Based on cohorts recruited in South Africa and other African countries, modelling studies have estimated that implementation of AlereLAM within TB diagnostic algorithms is also cost-effective. 14,15 Simplifying the criteria for AlereLAM as far as possible would likely improve its uptake and implementation, but this needs to be balanced against diagnostic yield of the criteria considered, which in turn impacts cost-effectiveness.…”

Section: Discussionmentioning

confidence: 99%

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Urine lipoarabinomannan for rapid tuberculosis diagnosis in HIV-infected adult outpatients in Khayelitsha

Sossen

Ryan

Bielawski

et al. 2021

Southern African Journal of HIV Medicine

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Background: Decreasing tuberculosis (TB) mortality is constrained by diagnostic and treatment delays. The World Health Organization (WHO) recently actively recommended the point-of-care Alere Determine Lipoarabinomannan Ag assay (AlereLAM) to assist in the diagnosis of tuberculosis in specific HIV-infected outpatients. Objectives:The primary objective of this study was to compare time to ambulatory TB treatment in HIV-infected adults with CD4 ≤ 100 cells/μL before and after ('primary comparison groups') availability of AlereLAM. In pre-specified subgroups, we prospectively assessed AlereLAM-positive prevalence.Method: Clinicians prospectively performed AlereLAM in HIV-infected adults with TB symptoms and either CD4 ≤ 100 cells/μL or 'seriously ill' criteria. In a retrospective arm of equal duration, clinicians retrospectively collected data on HIV-infected adults with CD4 ≤ 100 cells/μL who initiated TB treatment.Results: A total of 115 prospectively eligible adults (of whom 55 had CD4 ≤ 100 cells/μL) and 77 retrospectively eligible patients were included. In the primary comparison groups, the retrospective and prospective arms had similar age and sex distribution. With availability of AlereLAM, the time to TB treatment decreased from a median of 4 to 3 days ( p = 0.0557). With availability of AlereLAM, same-day TB treatment initiation rose from 9.1% to 32.7% ( p = 0.0006). In those with CD4 ≤ 100 only, those with 'seriously ill' criteria only, and in those meeting either, or both, of these criteria, AlereLAM was positive in 10.5%, 21.9%, 34.8% and 48.4% respectively. Conclusion:Availability of AlereLAM led to more patients initiating same-day TB treatment. Using both CD4 ≤ 100 and 'seriously ill' criteria gave the greatest yield. Results of this study have informed local policy design.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Urine lipoarabinomannan for rapid tuberculosis diagnosis in HIV-infected adult outpatients in Khayelitsha

Sossen

Ryan

Bielawski

et al. 2021

Southern African Journal of HIV Medicine

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“…The prior health economics analyses of the rapid TB testing in high-burden countries were mostly focused on the Xpert and AlereLAM. Three decision-analytic models and a microsimulation model analysis showed that the addition of AlereLAM to Xpert detected more TB cases and was cost-effective (ICER range: 24 USD/DALY-731 USD/DALY averted; 420-810 USD per years-of-life saved (YLS)) for HIV-positive patients in high-burden settings of Malawi, Uganda, South Africa, and Kenya [53][54][55][56]. A recent cost-effectiveness analysis by evaluated Xpert, Xpert with AlereLAM and Xpert with FujiLAM, and reported that ICER of Xpert+ Fuji-LAM versus Xpert alone was 830 USD/YLS in South Africa and 440 USD /YLS in Malawi [36].…”

Section: Plos Onementioning

confidence: 99%

Standard diagnostics with and without urine-based lipoarabinomannan testing for tuberculosis disease in HIV-infected patients in a high-burden setting–A cost-effectiveness analysis

2023

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Background Recent clinical findings reported the reduced mortality associated with treatment guided by sputum-based molecular test with urine-based lipoarabinomannan (LAM) assay for tuberculosis (TB) disease in HIV-infected individuals. We aimed to evaluate the cost-effectiveness of sputum-based Xpert tests with and without urine-based LAM assays among HIV-infected individuals with signs and symptoms of TB disease (TBD) from the perspective of South African healthcare providers. Methods A one-year decision-analytic model was constructed to simulate TB-related outcomes of 7 strategies: Sputum smear microscope (SSM), Xpert, Xpert Ultra, Xpert with AlereLAM, Xpert Ultra with AlereLAM, Xpert with FujiLAM, and Xpert Ultra with FujiLAM, in a hypothetical cohort of adult HIV-infected individuals with signs and symptoms of TB. The model outcomes were TB-related direct medical cost, mortality, early treatment, disability-adjusted life-years (DALYs) and incremental cost per DALY averted (ICER). The model inputs were retrieved from literature and public data. Base-case analysis and sensitivity analysis were conducted. Results In the base-case analysis, the Xpert Ultra with FujiLAM strategy showed the highest incidence of early treatment (267.7 per 1000 tested) and lowest mortality (29.0 per 1000 tested), with ICER = 676.9 USD/DALY averted. Probabilistic sensitivity analysis of 10,000 Monte Carlo simulations showed the cost-effective probability of Xpert Ultra with FujiLAM was the highest of all 7 strategies at the willingness-to-pay (WTP) threshold >202USD/DALY averted. Conclusion Standard sputum-based TB diagnostic Xpert Ultra with urine-based FujiLAM for TBD testing in HIV-infected individuals appears to be the preferred cost-effective strategy from the perspective of the health service provider of South Africa.

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“…Eight countries Accounted for 87% of the world's total new TB cases in 2018 with India leading the tally, followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa. Treatment adherence is a major factor in the failure of the pulmonary TB treatment program &Yakhelef et al, 2020.…”

Section: Introductionmentioning

confidence: 99%

Effect of Self Management Education on Knowledge and Self Efficacy of pulmonary TB Clients in Timor Tribal Community

Nuwa

Kiik

2021

JNK

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Background: Pulmonary Tuberculosis (TB) disease is still the main cause of death among the poor with low knowledge. Knowledge and self efficacy are the keys to the successful management of pulmonary TB. Objective: The purpose of this study was to investigate the effect of self management education (SME) by emphasizing the five pillars of TB management on knowledge and self efficacy of pulmonary TB clients in the Timor tribal community in Kupang, Indonesia. Methods: This quasi experimental study was conducted on 30 primary pulmonary tuberculosis patients who undergoing treatment for 6 months. The research was conducted from January to October 2020 in the working area of the Naibonat Community Health Center, Kupang Regency. Data were collected using a questionnaire on demographic data, knowledge and self efficacy which had been tested for validity and reliability.. Data were analyzed by the Paired T-test with SPSS 21. Results: The mean score of pre test knowledge and self efficacy of clients with pulmonary TB, respectively, 5.23 ± 1.04 and 4.77 ± 1.07 increased significantly to 6, 33 ± 1.18, and 7.13 ± 0.94 on the post test (P <0.001). Conclusion and recommendation: giving SME by emphasizing the five pillars of pulmonary TB management increases the knowledge and self-efficacy of pulmonary TB clients in the Timor tribal community. The recommendation of this study is that SME interventions can be used as one of the nursing interventions in the public health center in community empowerment based pulmonary TB management

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Cost-effectiveness of diagnostic algorithms including lateral-flow urine lipoarabinomannan for HIV-positive patients with symptoms of tuberculosis

Cited by 7 publications

References 25 publications

Urine lipoarabinomannan for rapid tuberculosis diagnosis in HIV-infected adult outpatients in Khayelitsha

Urine lipoarabinomannan for rapid tuberculosis diagnosis in HIV-infected adult outpatients in Khayelitsha

Standard diagnostics with and without urine-based lipoarabinomannan testing for tuberculosis disease in HIV-infected patients in a high-burden setting–A cost-effectiveness analysis

Effect of Self Management Education on Knowledge and Self Efficacy of pulmonary TB Clients in Timor Tribal Community

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