Is introducing rapid culture into the diagnostic algorithm of smear-negative tuberculosis cost-effective?

Yakhelef, Nadia; Audibert, Martine; Varaine, Francis; Chakaya, Jeremiah; Sitienei, Joseph; Huerga, Helena; Bonnet, Marilyne

doi:10.5588/ijtld.13.0630

Cited by 7 publications

(19 citation statements)

References 17 publications

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“…The cost evaluation was based on the analysis of the production costs [17]. "Micro-costing" method was adopted for costs of implementing each algorithm [19]. The evaluation of the costs was done by identifying, measuring and valuating the resources used in the production process [17][18][19][20].…”

Section: Cost Estimationmentioning

confidence: 99%

“…"Micro-costing" method was adopted for costs of implementing each algorithm [19]. The evaluation of the costs was done by identifying, measuring and valuating the resources used in the production process [17][18][19][20]. The same costing approach that Yakhelef et al [19] was adopted.…”

Section: Cost Estimationmentioning

confidence: 99%

“…The evaluation of the costs was done by identifying, measuring and valuating the resources used in the production process [17][18][19][20]. The same costing approach that Yakhelef et al [19] was adopted. So, for each test or test prescribed, variable and fixed costs were considered.…”

Section: Cost Estimationmentioning

confidence: 99%

“…Variable costs estimates were based on expenditures established a posteriori from quantities actually used (consumables, fuel, medicine, actual working time) and from prices in the Kenyan market in 2013 and 2014, using a conversion rate of 113.55 KES for 2013; 118.96 KES for 2014 and 110.12 KES for 2015 (Kenyan shilling) for €1 (www.fxtop.com). Joint costs were calculated based upon allocation keys [17][18][19]. Costs for clinician, nurse, radiologist and laboratory technician were calculated by multiplying the time spent in the activity by the cost of a unit (minute) of work time or from the average number of patients per day (for supervisory staff).…”

Section: Cost Estimationmentioning

confidence: 99%

“…For LF-LAM tests, medical material was two Ependorff pipettes. Based on the nomenclature used by the city of Lyon [21], the lifetime for depreciation estimates is 10 years for laboratory equipment, 15 years for air conditioning, 7 years for refrigerators and 25 years for buildings [19]. The total cost was estimated by adding the cost of all categories listed above according to their use in each algorithm.…”

Section: Cost Estimationmentioning

confidence: 99%

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

Yakhelef¹,

Audibert

Ferlazzo

et al. 2020

PLoS ONE

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BackgroundTuberculosis (TB) is the leading cause of death among HIV-positive patients. We assessed the cost-effectiveness of including lateral-flow urine lipoarabinomannan (LF-LAM) in TB diagnostic algorithms for severely ill or immunosuppressed HIV-positive patients with symptoms of TB in Kenya. MethodsFrom a decision-analysis tree, ten diagnostic algorithms were elaborated and compared. All algorithms included clinical exam. The costs of each algorithm were calculated using a 'micro-costing' method. The efficacy was estimated through a prospective study that included severely ill or immunosuppressed (CD4<200cells/μL) HIV-positive adults with symptoms of TB. The cost-effectiveness analysis was performed using the disabilityadjusted life year (DALY) averted as effectiveness outcome. A 4% discount rate was applied.

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Section: Cost Estimationmentioning

confidence: 99%

Section: Cost Estimationmentioning

confidence: 99%

Section: Cost Estimationmentioning

confidence: 99%

Section: Cost Estimationmentioning

confidence: 99%

Section: Cost Estimationmentioning

confidence: 99%

See 3 more Smart Citations

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

Yakhelef¹,

Audibert

Ferlazzo

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

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A Systematic Review of Methodological Variation in Healthcare Provider Perspective Tuberculosis Costing Papers Conducted in Low- and Middle-Income Settings, Using An Intervention-Standardised Unit Cost Typology

et al. 2020

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Background There is a need for easily accessible tuberculosis unit cost data, as well as an understanding of the variability of methods used and reporting standards of that data. Objective The aim of this systematic review was to descriptively review papers reporting tuberculosis unit costs from a healthcare provider perspective looking at methodological variation; to assess quality using a study quality rating system and machine learning to investigate the indicators of reporting quality; and to identify the data gaps to inform standardised tuberculosis unit cost collection and consistent principles for reporting going forward. Methods We searched grey and published literature in five sources and eight databases, respectively, using search terms linked to cost, tuberculosis and tuberculosis health services including tuberculosis treatment and prevention. For inclusion, the papers needed to contain empirical unit cost estimates for tuberculosis interventions from low-and middle-income countries, with reference years between 1990 and 2018. A total of 21,691 papers were found and screened in a phased manner. Data were extracted from the eligible papers into a detailed Microsoft Excel tool, extensively cleaned and analysed with R software (R Project, Vienna, Austria) using the user interface of RStudio. A study quality rating was applied to the reviewed papers based on the inclusion or omission of a selection of variables and their relative importance. Following this, machine learning using a recursive partitioning method was utilised to construct a classification tree to assess the reporting quality. Results This systematic review included 103 provider perspective papers with 627 unit costs (costs not presented here) for tuberculosis interventions among a total of 140 variables. The interventions covered were active, passive and intensified case finding; tuberculosis treatment; above-service costs; and tuberculosis prevention. Passive case finding is the detection of tuberculosis cases where individuals self-identify at health facilities; active case finding is detection of cases of those not in health facilities, such as through outreach; and intensified case finding is detection of cases in high-risk populations. There was heterogeneity in some of the reported methods used such cost allocation, amortisation and the use of top-down, bottom-up or mixed approaches to the costing. Uncertainty checking through sensitivity analysis was only reported on by half of the papers (54%), while purposive and convenience sampling was reported by 72% of papers. Machine learning indicated that reporting on 'Intervention' (in particular), 'Urbanicity' and 'Site Sampling', were the most likely indicators of quality of reporting. The largest data gap identified was for tuberculosis vaccination cost data, the Bacillus Calmette-Guérin (BCG) vaccine in particular. There is a gap in available unit costs for 12 of 30 high tuberculosis burden countries, as well as for the interventions of above-service costs, tuberculosis prevention, and ...

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Economic Analyses of Respiratory Tract Infection Diagnostics: A Systematic Review

et al. 2021

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Background Diagnostic testing for respiratory tract infections is a tool to manage the current COVID-19 pandemic, as well as the rising incidence of antimicrobial resistance. At the same time, new European regulations for market entry of in vitro diagnostics, in the form of the in vitro diagnostic regulation, may lead to more clinical evidence supporting health-economic analyses. Objective The objective of this systematic review was to review the methods used in economic evaluations of applied diagnostic techniques, for all patients seeking care for infectious diseases of the respiratory tract (such as pneumonia, pulmonary tuberculosis, influenza, sinusitis, pharyngitis, sore throats and general respiratory tract infections). Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles from three large databases of scientific literature were included (Scopus, Web of Science and PubMed) for the period January 2000 to May 2020. Results A total of 70 economic analyses are included, most of which use decision tree modelling for diagnostic testing for respiratory tract infections in the community-care setting. Many studies do not incorporate a generally comparable clinical outcome in their cost-effectiveness analysis: fewer than half the studies (33/70) used generalisable outcomes such as qualityadjusted life-years. Other papers consider outcomes related to the accuracy of the test or outcomes related to the prescribed treatment. The time horizons of the studies generally are limited. Conclusions The methods to economically assess diagnostic tests for respiratory tract infections vary and would benefit from clear recommendations from policy makers on the assessed time horizon and outcomes used.Simon van der Pol and Paula Rojas Garcia contributed equally to the article.

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Is introducing rapid culture into the diagnostic algorithm of smear-negative tuberculosis cost-effective?

Abstract: Despite the increase in patients started on treatment thanks to culture, the relatively high cost of a culture-based algorithm will make it difficult for resource-limited countries to afford.

Cited by 7 publications

References 17 publications

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

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

A Systematic Review of Methodological Variation in Healthcare Provider Perspective Tuberculosis Costing Papers Conducted in Low- and Middle-Income Settings, Using An Intervention-Standardised Unit Cost Typology

Economic Analyses of Respiratory Tract Infection Diagnostics: A Systematic Review

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