• Login
    View Item 
    •   Home
    • 1 Published Research and Commentary
    • TB
    • View Item
    •   Home
    • 1 Published Research and Commentary
    • TB
    • View Item
    Apr 14, 2021
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of MSFTitleAuthorsSubjectsPublisherJournalThis CollectionTitleAuthorsSubjectsPublisherJournal

    Cost-effectiveness of diagnostic algorithms including lateral-flow urine lipoarabinomannan for HIV-positive patients with symptoms of tuberculosis

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Thumbnail
    Name:
    Yakhelef et al 2020 Cost-effec ...
    Size:
    1.343Mb
    Format:
    PDF
    Download
    Authors
    Yakhelef, N
    Audibert, M
    Ferlazzo, G
    Sitienei, J
    Wanjala, S
    Varaine, F
    Bonnet, M
    Huerga, H
    Issue Date
    2020-01-30
    Submitted date
    2020-02-06
    
    Metadata
    Show full item record
    Journal
    PLoS ONE
    Abstract
    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 clinic&microscopy) 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.
    Publisher
    Public Library of Science
    URI
    http://hdl.handle.net/10144/619602
    DOI
    10.1371/journal.pone.0227138
    PubMed ID
    31999746
    Language
    en
    ISSN
    1932-6203
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pone.0227138
    Scopus Count
    Collections
    TB

    entitlement

    Related articles

    • Cost-effectiveness of novel algorithms for rapid diagnosis of tuberculosis in HIV-infected individuals in Uganda.
    • Authors: Shah M, Dowdy D, Joloba M, Ssengooba W, Manabe YC, Ellner J, Dorman SE
    • Issue date: 2013 Nov 28
    • Delayed diagnosis and treatment of tuberculosis in HIV+ patients in Mozambique: A cost-effectiveness analysis of screening protocols based on four symptom screening, smear microscopy, urine LAM test and Xpert MTB/RIF.
    • Authors: Orlando S, Triulzi I, Ciccacci F, Palla I, Palombi L, Marazzi MC, Giuliano M, Floridia M, Mancinelli S, Mutemba E, Turchetti G
    • Issue date: 2018
    • Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in HIV-positive adults.
    • Authors: Shah M, Hanrahan C, Wang ZY, Dendukuri N, Lawn SD, Denkinger CM, Steingart KR
    • Issue date: 2016 May 10
    • Diagnostic value of the urine lipoarabinomannan assay in HIV-positive, ambulatory patients with CD4 below 200 cells/μl in 2 low-resource settings: A prospective observational study.
    • Authors: Huerga H, Mathabire Rucker SC, Cossa L, Bastard M, Amoros I, Manhiça I, Mbendera K, Telnov A, Szumilin E, Sanchez-Padilla E, Molfino L
    • Issue date: 2019 Apr
    • Incremental Yield of Including Determine-TB LAM Assay in Diagnostic Algorithms for Hospitalized and Ambulatory HIV-Positive Patients in Kenya.
    • Authors: Huerga H, Ferlazzo G, Bevilacqua P, Kirubi B, Ardizzoni E, Wanjala S, Sitienei J, Bonnet M
    • Issue date: 2017
    DSpace software (copyright © 2002 - 2021)  DuraSpace
    Quick Guide | Contact Us
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.