Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis
- Equal contributors
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
BMC Infectious Diseases 2009, 9:216 doi:10.1186/1471-2334-9-216Published: 31 December 2009
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.
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.
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.
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.