Added value of bleach sedimentation microscopy for diagnosis of tuberculosis: a cost-effectiveness study.

Hdl Handle:
http://hdl.handle.net/10144/114126
Title:
Added value of bleach sedimentation microscopy for diagnosis of tuberculosis: a cost-effectiveness study.
Authors:
Bonnet, M; Tajahmady, A; Hepple, P; Ramsay, A; Githui, W; Gagdnidze, L; Guérin, P J; Varaine, F
Journal:
International Journal of Tuberculosis and Lung Disease
Abstract:
SETTING: Bleach sedimentation is a method used to increase the diagnostic yield of sputum microscopy for countries with a high prevalence of human immunodeficiency virus (HIV) infection and limited resources. OBJECTIVES: To compare the relative cost-effectiveness of different microscopy approaches in diagnosing tuberculosis (TB) in Kenya. METHODS: An analytical decision tree model including cost and effectiveness measures of 10 combinations of direct (D) and overnight bleach (B) sedimentation microscopy was constructed. Data were drawn from the evaluation of the bleach sedimentation method on two specimens (first on the spot [1] and second morning [2]) from 644 TB suspects in a peripheral health clinic. Incremental cost per smear-positive detected case was measured. Costs included human resources and materials using a micro-costing evaluation. RESULTS: All bleach-based microscopy approaches detected significantly more cases (between 23.3% for B1 and 25.9% for B1+B2) than the conventional D1+D2 approach (21.0%). Cost per tested case ranged between respectively euro 2.7 and euro 4.5 for B1 and B1+D2+B2. B1 and B1+B2 were the most cost-effective approaches. D1+B2 and D1+B1 were good alternatives to avoid using approaches exclusively based on bleach sedimentation microscopy. CONCLUSIONS: Among several effective microscopy approaches used, including sodium hypochlorite sedimentation, only some resulted in a limited increase in the laboratory workload and would be most suitable for programmatic implementation.
Affiliation:
Epicentre, Paris, France; Mission Nationale d’Expertise et d’Audit Hospitaliers, Paris, France; Manson Unit, Médecins Sans Frontières, London, UK; Liverpool School of Tropical Medicine, Liverpool, UK; United Nation’s Children’s Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training for Tropical Diseases, Geneva, Switzerland; Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya; Médecins Sans Frontières, Paris, France
Issue Date:
9-Apr-2010
URI:
http://hdl.handle.net/10144/114126
PubMed ID:
20392349
Additional Links:
http://www.ncbi.nlm.nih.gov/pubmed
Submitted date:
2010-10-14
Type:
Article
Language:
en
ISSN:
1815-7920
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorBonnet, Men
dc.contributor.authorTajahmady, Aen
dc.contributor.authorHepple, Pen
dc.contributor.authorRamsay, Aen
dc.contributor.authorGithui, Wen
dc.contributor.authorGagdnidze, Len
dc.contributor.authorGuérin, P Jen
dc.contributor.authorVaraine, Fen
dc.date.accessioned2010-10-29T14:26:43Z-
dc.date.available2010-10-29T14:26:43Z-
dc.date.issued2010-04-09-
dc.date.submitted2010-10-14-
dc.identifier.citationInt J Tuberc Lung Dis 2010;14(5):571-7en
dc.identifier.issn1815-7920-
dc.identifier.pmid20392349-
dc.identifier.urihttp://hdl.handle.net/10144/114126-
dc.description.abstractSETTING: Bleach sedimentation is a method used to increase the diagnostic yield of sputum microscopy for countries with a high prevalence of human immunodeficiency virus (HIV) infection and limited resources. OBJECTIVES: To compare the relative cost-effectiveness of different microscopy approaches in diagnosing tuberculosis (TB) in Kenya. METHODS: An analytical decision tree model including cost and effectiveness measures of 10 combinations of direct (D) and overnight bleach (B) sedimentation microscopy was constructed. Data were drawn from the evaluation of the bleach sedimentation method on two specimens (first on the spot [1] and second morning [2]) from 644 TB suspects in a peripheral health clinic. Incremental cost per smear-positive detected case was measured. Costs included human resources and materials using a micro-costing evaluation. RESULTS: All bleach-based microscopy approaches detected significantly more cases (between 23.3% for B1 and 25.9% for B1+B2) than the conventional D1+D2 approach (21.0%). Cost per tested case ranged between respectively euro 2.7 and euro 4.5 for B1 and B1+D2+B2. B1 and B1+B2 were the most cost-effective approaches. D1+B2 and D1+B1 were good alternatives to avoid using approaches exclusively based on bleach sedimentation microscopy. CONCLUSIONS: Among several effective microscopy approaches used, including sodium hypochlorite sedimentation, only some resulted in a limited increase in the laboratory workload and would be most suitable for programmatic implementation.en
dc.language.isoenen
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmeden
dc.rightsArchived with thanks to The International Journal of Tuberculosis and Lung Disease : the official journal of the International Union against Tuberculosis and Lung Diseaseen
dc.subject.meshCentrifugationen
dc.subject.meshCost-Benefit Analysisen
dc.subject.meshKenyaen
dc.subject.meshMicroscopyen
dc.subject.meshSodium Hypochloriteen
dc.subject.meshSputumen
dc.subject.meshTime Factorsen
dc.subject.meshTuberculosis, Pulmonaryen
dc.titleAdded value of bleach sedimentation microscopy for diagnosis of tuberculosis: a cost-effectiveness study.en
dc.typeArticleen
dc.contributor.departmentEpicentre, Paris, France; Mission Nationale d’Expertise et d’Audit Hospitaliers, Paris, France; Manson Unit, Médecins Sans Frontières, London, UK; Liverpool School of Tropical Medicine, Liverpool, UK; United Nation’s Children’s Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training for Tropical Diseases, Geneva, Switzerland; Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya; Médecins Sans Frontières, Paris, Franceen
dc.identifier.journalInternational Journal of Tuberculosis and Lung Diseaseen

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