Cost-effectiveness of diagnostic algorithms including lateral-flow urine lipoarabinomannan for HIV-positive patients with symptoms of tuberculosis.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
22
07
2019
accepted:
12
12
2019
entrez:
31
1
2020
pubmed:
31
1
2020
medline:
9
4
2020
Statut:
epublish
Résumé
Tuberculosis (TB) is the leading cause of death among HIV-positive patients. We assessed the cost-effectiveness of including lateral-flow urine lipoarabinomannan (LF-LAM) in TB diagnostic algorithms for severely ill or immunosuppressed HIV-positive patients with symptoms of TB in Kenya. From a decision-analysis tree, ten diagnostic algorithms were elaborated and compared. All algorithms included clinical exam. The costs of each algorithm were calculated using a 'micro-costing' method. The efficacy was estimated through a prospective study that included severely ill or immunosuppressed (CD4<200cells/μL) HIV-positive adults with symptoms of TB. The cost-effectiveness analysis was performed using the disability-adjusted life year (DALY) averted as effectiveness outcome. A 4% discount rate was applied. The algorithm that added LF-LAM alone to the clinical exam lead to the least average cost per TB case detected (€47) and was the most cost-effective with a cost/DALY averted of €4.6. The algorithms including LF-LAM, microscopy and X-ray, and LF-LAM and Xpert in sputum, detected a high number of TB cases with a cost/DALY averted of €6.1 for each of them. In the comparisons of the algorithms two by two, using LF-LAM instead of microscopy (clinic&LAM vs clinicµscopy) and using LF-LAM along with GeneXpert in sputum instead of GeneXpert in urine along with GeneXpert in sputum, (clinic&LAM&Xpert_sputum vs clinic&Xpert_sputum&Xpert_urine) led to the highest increase in the cost-effectiveness ratios (ICERs): €-7.2 and €-12.6 respectively. In these two comparisons, using LF-LAM increased the number of TB patients detected while reducing costs. Adding LF-LAM to smear microscopy alone or to smear microscopy and Xray led to the highest increase in the additional number of TB cases detected (31 and 25 respectively) with an incremental efficiency estimated at 134 and 344 DALYs respectively. The ICERs were €22.0 and €8.6 respectively. Including LF-LAM in TB diagnostic algorithms is cost-effective for severely ill or immunosuppressed HIV-positive patients.
Sections du résumé
BACKGROUND
Tuberculosis (TB) is the leading cause of death among HIV-positive patients. We assessed the cost-effectiveness of including lateral-flow urine lipoarabinomannan (LF-LAM) in TB diagnostic algorithms for severely ill or immunosuppressed HIV-positive patients with symptoms of TB in Kenya.
METHODS
From a decision-analysis tree, ten diagnostic algorithms were elaborated and compared. All algorithms included clinical exam. The costs of each algorithm were calculated using a 'micro-costing' method. The efficacy was estimated through a prospective study that included severely ill or immunosuppressed (CD4<200cells/μL) HIV-positive adults with symptoms of TB. The cost-effectiveness analysis was performed using the disability-adjusted life year (DALY) averted as effectiveness outcome. A 4% discount rate was applied.
RESULTS
The algorithm that added LF-LAM alone to the clinical exam lead to the least average cost per TB case detected (€47) and was the most cost-effective with a cost/DALY averted of €4.6. The algorithms including LF-LAM, microscopy and X-ray, and LF-LAM and Xpert in sputum, detected a high number of TB cases with a cost/DALY averted of €6.1 for each of them. In the comparisons of the algorithms two by two, using LF-LAM instead of microscopy (clinic&LAM vs clinicµscopy) and using LF-LAM along with GeneXpert in sputum instead of GeneXpert in urine along with GeneXpert in sputum, (clinic&LAM&Xpert_sputum vs clinic&Xpert_sputum&Xpert_urine) led to the highest increase in the cost-effectiveness ratios (ICERs): €-7.2 and €-12.6 respectively. In these two comparisons, using LF-LAM increased the number of TB patients detected while reducing costs. Adding LF-LAM to smear microscopy alone or to smear microscopy and Xray led to the highest increase in the additional number of TB cases detected (31 and 25 respectively) with an incremental efficiency estimated at 134 and 344 DALYs respectively. The ICERs were €22.0 and €8.6 respectively.
CONCLUSION
Including LF-LAM in TB diagnostic algorithms is cost-effective for severely ill or immunosuppressed HIV-positive patients.
Identifiants
pubmed: 31999746
doi: 10.1371/journal.pone.0227138
pii: PONE-D-19-20635
pmc: PMC6992347
doi:
Substances chimiques
Biomarkers
0
Lipopolysaccharides
0
lipoarabinomannan
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0227138Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
BMC Infect Dis. 2017 Dec 28;17(1):803
pubmed: 29282005
Int J Tuberc Lung Dis. 2013 Apr;17(4):552-8
pubmed: 23485389
J Health Econ. 1997 Feb;16(1):1-31
pubmed: 10167341
Stat Methods Med Res. 2002 Dec;11(6):455-68
pubmed: 12516984
Med Decis Making. 1985 Summer;5(2):157-77
pubmed: 3831638
J Am Coll Cardiol. 2008 Dec 16;52(25):2119-26
pubmed: 19095128
Expert Rev Pharmacoecon Outcomes Res. 2001 Oct;1(1):25-36
pubmed: 19807505
Int J Tuberc Lung Dis. 2009 Sep;13(9):1130-6
pubmed: 19723403
Cost Eff Resour Alloc. 2003 Dec 19;1(1):8
pubmed: 14687420
Value Health. 2013 Mar-Apr;16(2):231-50
pubmed: 23538175
Cochrane Database Syst Rev. 2016 May 10;(5):CD011420
pubmed: 27163343
Pharmacoeconomics. 2009;27(11):903-17
pubmed: 19888791
Health Econ. 2001 Dec;10(8):779-87
pubmed: 11747057
Value Health. 2005 Sep-Oct;8(5):521-33
pubmed: 16176491
Lancet. 2012 Dec 15;380(9859):2129-43
pubmed: 23245605
AIDS. 2014 Jun 1;28(9):1307-14
pubmed: 24637544
Int J Tuberc Lung Dis. 2014 May;18(5):541-6
pubmed: 24903790
Lancet Glob Health. 2019 Feb;7(2):e200-e208
pubmed: 30683239
PLoS One. 2015 Feb 06;10(2):e0117009
pubmed: 25658592
PLoS One. 2017 Jan 26;12(1):e0170976
pubmed: 28125693
Int J Tuberc Lung Dis. 2008 Sep;12(9):1021-9
pubmed: 18713499
Am J Public Health. 2000 Aug;90(8):1241-7
pubmed: 10937004
Lancet. 2007 Jun 16;369(9578):2042-2049
pubmed: 17574096
Med Decis Making. 1990 Jul-Sep;10(3):212-4
pubmed: 2115096
Lancet Infect Dis. 2012 Mar;12(3):201-9
pubmed: 22015305
N Engl J Med. 2010 Feb 25;362(8):707-16
pubmed: 20181972