Impact and Cost-Effectiveness of Culture for Diagnosis of Tuberculosis in HIV-Infected Brazilian Adults
Impact and Cost-Effectiveness of Culture for Diagnosis of Tuberculosis in HIV-Infected Brazilian Adults
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DOI：
10.1371/journal.pone.0004057
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发表时间：
2008-12-29
期刊：
影响因子：
3.7
通讯作者：
Dorman, Susan E.
中科院分区：
文献类型：
--
作者：
Dowdy, David W.;Lourenco, Maria C.;Dorman, Susan E.
背景资料：结核分枝杆菌培养目前代表了诊断结核病（TB）的最接近的“金标准”，但在资源有限的环境中，关于结核培养对人类免疫缺陷（HIV-）感染者的影响和成本效益的操作数据很少。方法/主要发现：我们记录了在巴西里约热内卢的一个艾滋病毒感染者结核病集中培养项目中开始结核病治疗的费用、实验室结果和日期，从公共部门结核病控制项目的角度构建结核病文化增量成本效益的决策分析模型。在2006年1月至2008年3月期间出现的217例结核病疑似病例中，33例（15%）经培养证实为活动性结核病; 23例（70%）涂片阴性。在涂片阴性、培养阳性的患者中，6例（26%）在获得培养结果前开始TB治疗，11例（48%）在获得培养结果后开始TB治疗，6例（26%）在出现后180天内未开始TB治疗。每个阴性培养物的成本为17.52美元（固体培养基）-23.50美元（液体培养基）。每1，000名结核病嫌疑人与单独涂片相比，使用固体培养基进行结核病培养可避免约8例结核病死亡（95%模拟间隔[SI]：4、15）和37残疾调整生命年（DALLS）（95% SI：13，76），每名结核病嫌疑人的成本为36美元（95% SI：25，50美元），或每避免DALY的成本为962美元（95% SI：469，2642美元）。用自动化液体培养替换固体培养基将避免另外一个死亡（95% SI：21，4）和8个DALY（95% SI：24，23），每DALY 2751美元（95% SI：680美元，占主导地位）。结核病文化的成本效益更敏感的特点，现有的结核病诊断系统比准确性或成本的TB culture.Conclusions/Significance：结核病文化是潜在的有效和成本效益的HIV阳性患者在资源有限的设置。将培养结果可靠地传递给患者并与现有系统集成至关重要。
Background: Culture of Mycobacterium tuberculosis currently represents the closest "gold standard" for diagnosis of tuberculosis (TB), but operational data are scant on the impact and cost-effectiveness of TB culture for human immunodeficiency (HIV-) infected individuals in resource-limited settings.Methodology/Principal Findings: We recorded costs, laboratory results, and dates of initiating TB therapy in a centralized TB culture program for HIV- infected patients in Rio de Janeiro, Brazil, constructing a decision-analysis model to estimate the incremental cost-effectiveness of TB culture from the perspective of a public-sector TB control program. Of 217 TB suspects presenting between January 2006 and March 2008, 33 (15%) had culture-confirmed active tuberculosis; 23 (70%) were smear-negative. Among smear- negative, culture-positive patients, 6 (26%) began TB therapy before culture results were available, 11 (48%) began TB therapy after culture result availability, and 6 ( 26%) did not begin TB therapy within 180 days of presentation. The cost per negative culture was US$ 17.52 (solid media)-$23.50 ( liquid media). Per 1,000 TB suspects and compared with smear alone, TB culture with solid media would avert an estimated eight TB deaths (95% simulation interval [SI]: 4, 15) and 37 disability-adjusted life years (DALYs) ( 95% SI: 13, 76), at a cost of $36( 95% SI: $25, $50) per TB suspect or $962 (95% SI: $469, $2642) per DALY averted. Replacing solid media with automated liquid culture would avert one further death (95% SI: 21, 4) and eight DALYs (95% SI: 24, 23) at $2751 per DALY 95% SI: $680, dominated). The cost-effectiveness of TB culture was more sensitive to characteristics of the existing TB diagnostic system than to the accuracy or cost of TB culture.Conclusions/Significance: TB culture is potentially effective and cost-effective for HIV- positive patients in resource-constrained settings. Reliable transmission of culture results to patients and integration with existing systems are essential.