Cost-effectiveness of WHO-Recommended Algorithms for TB Case Finding at Ethiopian HIV Clinics
Year: 2017
Type: article
Abstract: BACKGROUND: The World Health Organization (WHO) recommends active tuberculosis (TB) case finding and a rapid molecular diagnostic test (Xpert MTB/RIF) to detect TB among people living with HIV (PLHIV) in high-burden settings. Information on the cost-effectiveness of these recommended strategies is crucial for their implementation. METHODS: We conducted a model-based cost-effectiveness analysis comparing 2 algorithms for TB screening and diagnosis at Ethiopian HIV clinics: (1) WHO-recommended symptom screen combined with Xpert for PLHIV with a positive symptom screen and (2) current recommended practice algorithm (CRPA; based on symptom screening, smear microscopy, and clinical TB diagnosis). Our primary outcome was US$ per disability-adjusted life-year (DALY) averted. Secondary outcomes were additional true-positive diagnoses, and false-negative and false-positive diagnoses averted. RESULTS: Compared with CRPA, combining a WHO-recommended symptom screen with Xpert was highly cost-effective (incremental cost of $5 per DALY averted). Among a cohort of 15 000 PLHIV with a TB prevalence of 6% (900 TB cases), this algorithm detected 8 more true-positive cases than CRPA, and averted 2045 false-positive and 8 false-negative diagnoses compared with CRPA. The WHO-recommended algorithm was marginally costlier ($240 000) than CRPA ($239 000). In sensitivity analysis, the symptom screen/Xpert algorithm was dominated at low Xpert sensitivity (66%). CONCLUSIONS: In this model-based analysis, combining a WHO-recommended symptom screen with Xpert for TB diagnosis among PLHIV was highly cost-effective ($5 per DALY averted) and more sensitive than CRPA in a high-burden, resource-limited setting.
Source: Open Forum Infectious Diseases
DOI: 10.1093/ofid/ofx269
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
Funders: Global Fund to Fight AIDS, Tuberculosis and Malaria, World Health Organization, Emory University, National Institutes of Health, American Medical Association Foundation, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Center for Advancing Translational Sciences
Awards: G2289923368, Atlanta Clinical and Translational Science Institute (ACTSI) Renewal, Intra Cavitary Pharmacokinetics and Drug Resistance in Pulmonary Tuberculosis, G7094225672, Atlanta Clinical and Translational Science Institute (ACTSI) Renewal, Georgia Clinical & Translational Science Alliance (Georgia CTSA), Center for AIDS Prevention Studies (CAPS), Ethiopia-Emory TB Research Training Program
OpenAlex ID: W2560761786