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

Author

Listed:
  • Martine Audibert

    (CERDI - Centre d'Études et de Recherches sur le Développement International - UdA - Université d'Auvergne - Clermont-Ferrand I - CNRS - Centre National de la Recherche Scientifique)

  • Marilyne Bonnet

    (Epicentre [Paris] [Médecins Sans Frontières])

  • Jeremiah Chakaya

    (KEMRI - Kenya Medical Research Institute)

  • Helena Huerga

    (Epicentre [Paris] [Médecins Sans Frontières])

  • Joseph Sitienei

    (National Leprosy and TB Control Programme - National Leprosy and TB Control Programme - National Leprosy and TB Control Programme)

  • Francis Varaine

    (Medecins Sans Frontieres - Medecins Sans Frontieres - Médecins Sans Frontières)

  • Nadia Yakhelef

    (CERDI - Centre d'Études et de Recherches sur le Développement International - UdA - Université d'Auvergne - Clermont-Ferrand I - CNRS - Centre National de la Recherche Scientifique)

Abstract

S E T T I N G : In 2007, the World Health Organization recommended introducing rapid Mycobacterium tuberculosis culture into the diagnostic algorithm of smearnegative pulmonary tuberculosis (TB). O B J E C T IVE : To assess the cost-effectiveness of introducing a rapid non-commercial culture method (thinlayer agar), together with L¨ owenstein-Jensen culture to diagnose smear-negative TB at a district hospital in Kenya. D E S I G N : Outcomes (number of true TB cases treated) were obtained from a prospective study evaluating the effectiveness of a clinical and radiological algorithm (conventional) against the alternative algorithm (conventional plus M. tuberculosis culture) in 380 smearnegative TB suspects. The costs of implementing each algorithm were calculated using a 'micro-costing' or 'ingredient-based' method. We then compared the cost and effectiveness of conventional vs. culture-based algorithms and estimated the incremental cost-effectiveness ratio. RESULT S : The costs of conventional and culture-based algorithms per smear-negative TB suspect were respectively E39.5 and E144. The costs per confirmed and treated TB case were respectively E452 and E913. The culture-based algorithm led to diagnosis and treatment of 27 more cases for an additional cost of E1477 per case. CONCLUSION: 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.

Suggested Citation

  • Martine Audibert & Marilyne Bonnet & Jeremiah Chakaya & Helena Huerga & Joseph Sitienei & Francis Varaine & Nadia Yakhelef, 2014. "Is introducing rapid culture into the diagnostic algorithm of smear-negative tuberculosis cost-effective?," Post-Print halshs-00991625, HAL.
    • Handle: RePEc:hal:journl:halshs-00991625
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    Cited by:

    1. Nadia Yakhelef & Martine Audibert & Gabriella Ferlazzo & Joseph Sitienei & Steve Wanjala & Francis Varaine & Maryline Bonnet & Helena Huerga, 2020. "Cost-effectiveness of diagnostic algorithms including lateral-flow urine lipoarabinomannan for HIV-positive patients with symptoms of tuberculosis," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-17, January.
    2. Nadia Yakhelef & Martine Audibert & Gabriella Ferlazzo & Joseph Sitienei & Steve Wanjala & Francis Varaine & Maryline Bonnet & Helena Huerga, 2020. "Cost-effectiveness of diagnostic algorithms including lateral-flow urine lipoarabinomannan for HIV-positive patients with symptoms of tuberculosis," Post-Print halshs-03170014, HAL.

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