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

Martine Audibert (), Marilyne Bonnet, Jeremiah Chakaya, Helena Huerga, Joseph Sitienei, Francis Varaine and Nadia Yakhelef
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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

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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.

Keywords: economic evaluation; smear-negative pulmonary; TB diagnosis; health technology assessment (search for similar items in EconPapers)
Date: 2014
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Citations: View citations in EconPapers (2)

Published in International Journal of Tuberculosis and Lung Disease, 2014, 18 (5), pp.541-546

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:halshs-00991625

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