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Open Access Highly Accessed Research article

Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis

Luciene C Scherer12*, Rosa D Sperhacke2, Antonio Ruffino-Netto5, Maria LR Rossetti12, Claudia Vater3, Paul Klatser4 and Afrânio L Kritski3

Author Affiliations

1 Universidade Luterana do Brasil-ULBRA, Canoas/RS/Brazil

2 Centro de Desenvolvimento Científico e Tecnológico, CDCT, Fundação Estadual de Produção e Pesquisa em Saúde, FEPPS/RS) Porto Alegre/RS/Brazil

3 Programa Acadêmico de Tuberculose, Faculdade de Medicina/Complexo Hospitalar: HUCFF-IDT, Instituto de Saúde Coletiva/IESC/Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, Brazil

4 Royal Tropical Institute (KIT), KIT Biomedical Research, the Netherlands

5 Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil

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BMC Infectious Diseases 2009, 9:216  doi:10.1186/1471-2334-9-216

Published: 31 December 2009

Abstract

Background

Tuberculosis is one of the most prominent health problems in the world, causing 1.75 million deaths each year. Rapid clinical diagnosis is important in patients who have co-morbidities such as Human Immunodeficiency Virus (HIV) infection. Direct microscopy has low sensitivity and culture takes 3 to 6 weeks [1-3]. Therefore, new tools for TB diagnosis are necessary, especially in health settings with a high prevalence of HIV/TB co-infection.

Methods

In a public reference TB/HIV hospital in Brazil, we compared the cost-effectiveness of diagnostic strategies for diagnosis of pulmonary TB: Acid fast bacilli smear microscopy by Ziehl-Neelsen staining (AFB smear) plus culture and AFB smear plus colorimetric test (PCR dot-blot).

From May 2003 to May 2004, sputum was collected consecutively from PTB suspects attending the Parthenon Reference Hospital. Sputum samples were examined by AFB smear, culture, and PCR dot-blot. The gold standard was a positive culture combined with the definition of clinical PTB. Cost analysis included health services and patient costs.

Results

The AFB smear plus PCR dot-blot require the lowest laboratory investment for equipment (US$ 20,000). The total screening costs are 3.8 times for AFB smear plus culture versus for AFB smear plus PCR dot blot costs (US$ 5,635,760 versus US$ 1,498, 660). Costs per correctly diagnosed case were US$ 50,773 and US$ 13,749 for AFB smear plus culture and AFB smear plus PCR dot-blot, respectively. AFB smear plus PCR dot-blot was more cost-effective than AFB smear plus culture, when the cost of treating all correctly diagnosed cases was considered. The cost of returning patients, which are not treated due to a negative result, to the health service, was higher in AFB smear plus culture than for AFB smear plus PCR dot-blot, US$ 374,778,045 and US$ 110,849,055, respectively.

Conclusion

AFB smear associated with PCR dot-blot associated has the potential to be a cost-effective tool in the fight against PTB for patients attended in the TB/HIV reference hospital.