Cost-effectiveness of automated digital microscopy for diagnosis of active tuberculosis

Show simple item record Jha, Swati Ismail, Nazir Ahmed Clark, David Lewis, James J. Omar, Shaheed Dreyer, Andries Chihota, Violet Churchyard, Gavin Dowdy, David W. 2016-07-21T07:02:34Z 2016-07-21T07:02:34Z 2016-06-20
dc.description.abstract BACKGROUND Automated digital microscopy has the potential to improve the diagnosis of tuberculosis (TB), particularly in settings where molecular testing is too expensive to perform routinely. The cost-effectiveness of TB diagnostic algorithms using automated digital microscopy remains uncertain. METHODS Using data from a demonstration study of an automated digital microscopy system (TBDx, Applied Visual Systems, Inc.), we performed an economic evaluation of TB diagnosis in South Africa from the health system perspective. The primary outcome was the incremental cost per new TB diagnosis made. We considered costs and effectiveness of different algorithms for automated digital microscopy, including as a stand-alone test and with confirmation of positive results with Xpert MTB/RIF (‘Xpert’, Cepheid, Inc.). Results were compared against both manual microscopy and universal Xpert testing. RESULTS In settings willing to pay $2000 per incremental TB diagnosis, universal Xpert was the preferred strategy. However, where resources were not sufficient to support universal Xpert, and a testing volume of at least 30 specimens per day could be ensured, automated digital microscopy with Xpert confirmation of low-positive results could facilitate the diagnosis of 79–84% of all Xpert-positive TB cases, at 50–60% of the total cost. The cost-effectiveness of this strategy was $1280 per incremental TB diagnosis (95% uncertainty range, UR: $340-$3440) in the base case, but improved under conditions likely reflective of many settings in sub-Saharan Africa: $677 per diagnosis (95% UR: $450-$935) when sensitivity of manual smear microscopy was lowered to 0.5, and $956 per diagnosis (95% UR: $40-$2910) when the prevalence of multidrug-resistant TB was lowered to 1%. CONCLUSIONS Although universal Xpert testing is the preferred algorithm for TB diagnosis when resources are sufficient, automated digital microscopy can identify the majority of cases and halve the cost of diagnosis and treatment when resources are more scarce and multidrug-resistant TB is not common. en_ZA
dc.description.department Medical Microbiology en_ZA
dc.description.librarian am2016 en_ZA
dc.description.sponsorship Funded in part by the B. Frank and Kathleen Polk Assistant Professorship in Epidemiology (to DWD). Applied Visual Systems, Inc. support for open-access publication fees. en_ZA
dc.description.uri en_ZA
dc.identifier.citation Jha S, Ismail N, Clark D, Lewis JJ, Omar S, Dreyer A, et al. (2016) Cost-Effectiveness of Automated Digital Microscopy for Diagnosis of Active Tuberculosis. PLoS ONE 11(6): e0157554. DOI: 10.1371/journal.pone.0157554. en_ZA
dc.identifier.issn 1932-6203
dc.identifier.other 10.1371/journal.pone.0157554
dc.language.iso en en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights © 2016 Jha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License. en_ZA
dc.subject Molecular testing en_ZA
dc.subject TB diagnosis en_ZA
dc.subject Xpert testing en_ZA
dc.subject Tuberculosis (TB) en_ZA
dc.title Cost-effectiveness of automated digital microscopy for diagnosis of active tuberculosis en_ZA
dc.type Article en_ZA

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