NDLI: Cost-effectiveness of tuberculosis diagnostic strategies to reduce early mortality among persons with advanced HIV infection initiating antiretroviral therapy.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Abimbola, Taiwo O. Marston, Barbara J. Date, Anand A. Blandford, John M. Sangrujee, Nalinee Wiktor, Stefan Z.
Spatial Coverage	Africa South of the Sahara
Description	Country affiliation: United States Author Affiliation: Abimbola TO ( Center for Global Health, Centers for Disease Control and Prevention, Atlanta GA 30333, USA. tabimbola@cdc.gov)
Abstract	BACKGROUND: In sub-Saharan Africa, patients with advanced HIV experience high mortality during the first few months of antiretroviral therapy (ART), largely attributable to tuberculosis (TB). We evaluated the cost-effectiveness of TB diagnostic strategies to reduce this early mortality. METHODS: We developed a decision analytic model to estimate the incremental cost, deaths averted, and cost-effectiveness of 3 TB diagnostic algorithms. The model base case represents current practice (symptoms screening, sputum smear, and chest radiography) in many resource-limited countries in sub-Saharan Africa. We compared the current practice with World Health Organization (WHO)-recommended practice with culture and WHO-recommended practice with the Xpert mycobacterium tuberculosis and resistance to rifampicin test and considered relevant medical costs from a health system perspective using the timeframe of the first 6 months of ART. We conducted univariate and probabilistic sensitivity analyses on all parameters in the model. RESULTS: When considering TB diagnosis and treatment and ART costs, the cost per patient was \$850 for current practice, \$809 for the algorithm with Xpert test, and \$879 for the algorithm with culture. Our results showed that both WHO-recommended algorithms avert more deaths among TB cases than does the current practice. The algorithm with Xpert test was least costly at reducing early mortality compared with the current practice. Sensitivity analyses indicated that cost-effectiveness findings were stable. CONCLUSIONS: Our analysis showed that culture or Xpert were cost-effective at reducing early mortality during the first 6 months of ART compared with the current practice. Thus, our findings provide support for ongoing efforts to expand TB diagnostic capacity.
File Format	HTM / HTML
ISSN	15254135
Issue Number	1
Volume Number	60
e-ISSN	10779450
Journal	JAIDS Journal of Acquired Immune Deficiency Syndromes
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2012-05-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline AIDS Anti-hiv Agents Administration & Dosage Antiretroviral Therapy, Highly Active Clinical Laboratory Techniques Economics Methods Hiv Infections Complications Mycobacterium Tuberculosis Isolation & Purification Tuberculosis Diagnosis Africa South Of The Sahara Antitubercular Agents Pharmacology Cost-benefit Analysis Drug Therapy Mortality Humans Microbial Sensitivity Tests Models, Statistical Drug Effects Rifampin Survival Analysis Journal Article
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Pharmacology (medical)

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