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

Fekadu, Ginenus; Wang, Yingcheng; You, Joyce H. S.

doi:10.1371/journal.pone.0288605

Cited by 3 publications

References 39 publications

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Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses

Tomeny,

Hampton,

Tran

et al. 2024

PharmacoEconomics

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Background The disability-adjusted life year (DALY), a key metric for health resource allocation, encompasses morbidity through disability weights. Widely used in tuberculosis cost-effectiveness analysis (CEAs), DALYs play a significant role in informing intervention adopt/reject decisions. This study reviews the values and consistency of disability weights applied in tuberculosis-related CEAs. Methods We conducted a systematic review using the Tufts CEA database, updated to July 2023 with searches in Embase, Scopus and PubMed. Eligible studies needed to have included a cost-per-DALY ratio, and additionally either evaluated a tuberculosis (TB) intervention or included tuberculosis-related weights. We considered all tuberculosis health states: with/without human immunodeficiency virus (HIV) coinfection, TB treatments and treatment side effects. Data were screened and extracted independently by combinations of two authors. Findings A total of 105 studies spanning 2002–2023 across 50 countries (mainly low- and middle-income countries) were extracted. Disability weights were sourced primarily from the Global Burden of Disease (GBD; 100/165; 61%), with 17 non-GBD studies additionally referenced, along with primary derivation. Inconsistencies in the utilisation of weights were evident: of the 100 usages of GBD-sourced weights, only in 47 instances (47%) had the weight value been explicitly specified with an appropriate up-to-date reference cited (constituting 28% of all weight usages, 47/165). Sensitivity analyses on weight values had been conducted in 30% of studies (31/105). Twelve studies did not clearly specify weights or their sources; nine further calculated DALYs without morbidity. The review suggests methodological gaps in current approaches for representing important aspects of TB, including TB–HIV coinfection, treatment, drug-resistance, extrapulmonary TB and psychological impacts. We propose a set of best practice recommendations. Interpretation There is a need for increased rigour in the application, sensitivity testing and reporting of TB disability weights. Furthermore, there appears a desire among researchers to reflect elements of the tuberculosis experience beyond those allowed for by GBD disability weights. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-024-01410-x.

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Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses

Tomeny,

Hampton,

Tran

et al. 2024

PharmacoEconomics

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Cost-effectiveness of diagnostic tools and strategies for the screening and diagnosis of tuberculosis disease and infection: a scoping review

Ockhuisen,

de Nooy,

Jenkins

et al. 2024

bmjph

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The objective of this scoping review is to understand the cost-effectiveness of current and future tools/strategies for screening and diagnosis of tuberculosis (TB) infection and disease. To this end, PubMed, EMBASE and SCOPUS were used to identify any English language reports on the cost-effectiveness of TB infection/disease screening/diagnostic strategies published between 1 January 2017 and 7 October 2023. Studies included high-burden/risk TB populations, compared diagnostic/screening methods and conducted a cost-effectiveness/economic evaluation. We stratified the included articles in four groups (cost-effectiveness of diagnosing TB disease/infection and cost-effectiveness of screening for TB disease/infection). A full-text review was conducted, and relevant costing data extracted. Of the 2417 articles identified in the initial search, 112 duplicates were removed, and 2305 articles were screened for title and abstract. 23 full articles were reviewed, and 17 fulfilled all inclusion criteria. While sputum smear microscopy (SSM) has been the primary method of diagnosing TB disease in high-burden countries, the current body of literature suggests that SSM is likely to be the least cost-effective tool for the diagnosis of TB disease. Further scale-up with molecular diagnostics, such as GeneXpert and Truenat, was shown to be broadly cost-effective, with a multitest approach likely to be cost-effective for both screening and diagnosis. There is an urgent need to increase access and remove barriers to implementation of diagnostics that have been repeatedly shown to be cost-effective, as well as to develop new diagnostic and screening technologies/strategies to address current barriers to scale-up.

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Impact of the Introduction of a Package of Care Involving Early Detection of Opportunistic Infections in People Living with HIV/AIDS: A Pan American Health Organization (PAHO) Initiative in Brazil

Pasqualotto,

Sued,

Reis

et al. 2024

Preprint

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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

Cited by 3 publications

References 39 publications

Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses

Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses

Cost-effectiveness of diagnostic tools and strategies for the screening and diagnosis of tuberculosis disease and infection: a scoping review

Impact of the Introduction of a Package of Care Involving Early Detection of Opportunistic Infections in People Living with HIV/AIDS: A Pan American Health Organization (PAHO) Initiative in Brazil

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