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

  • Nadia YAKHELEF

    (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I)

  • Martine Audibert

    (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I)

  • Francis VARAINE

    (Médecins Sans Frontières - Médecins Sans Frontières - Médecins Sans Frontières)

  • Jeremiah CHAKAYA

    (Medical Research Institute - Medical Research Institute - Medical Research Institute)

  • Joseph SITIENEI

    (National Leprosy - National Leprosy - National Leprosy)

  • Helena HUERGA

    (Epicentre - Epicentre - Epicentre)

  • Marilyne BONNET

    (Epicentre - Epicentre - Epicentre)

Setting: In 2007, WHO recommended introducing rapid Mycobacterium tuberculosis (MTB) culture in the diagnostic algorithm of smear-negative pulmonary tuberculosis (TB). Objective: To assess the cost-effectiveness of the introduction of rapid non-commercial culture method (Thin Layer Agar) together with Löwenstein Jensen culture to diagnose smear-negative TB at a district hospital in Kenya. Design: Effectiveness data (number of true TB cases treated) were obtained from a prospective study evaluating the effectiveness of a clinical and radiological algorithm (conventional) with and without (culture-based) MTB culture in 380 smear-negative TB suspects. The costs of each algorithm were calculated using a "micro-costing" or "ingredient-based" method. The cost and effectiveness was compared between conventional and culture-based algorithms and the incremental cost-effectiveness ratio (ICER) was estimated. Results The cost of conventional and culture-based algorithms (per smear-negative TB case) was 15,026€ (39.5€) and 54,931€ (144€), respectively. The cost per TB confirmed and treated case was 455.3€ and 915.5€, respectively. The culture-based algorithm allowed to diagnose and treat 27 more cases for an additional cost of 39,905€ (1478€ per case). Conclusion MTB culture is cost-effective to diagnose smear-negative pulmonary TB according to WHO standards but did not reduce the cost of overtreatment due to long delay of culture results.

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Date of creation: 26 Sep 2013
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Handle: RePEc:hal:wpaper:halshs-00866530
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