Cost-effectiveness of novel algorithms for rapid diagnosis of tuberculosis in HIV-infected individuals in Uganda

Maunank Shah, David Wesley Dowdy, Moses Joloba, Willy Ssengooba, Yukari C Manabe, Jerrold Ellner, Susan E. Dorman

Research output: Contribution to journalArticle

Abstract

Objective: Xpert MTB/RIF ('Xpert') and urinary lateral-flow lipoarabinomannan (LF-LAM) assays offer rapid tuberculosis (TB) diagnosis. This study evaluated the cost-effectiveness of novel diagnostic algorithms utilizing combinations of Xpert and LF-LAM for the detection of active TB among people living with HIV. Design: Cost-effectiveness analysis using data from a comparative study of LF-LAM and Xpert, with a target population of HIV-infected individuals with signs/symptoms of TB in Uganda. Methods: A decision-analysis model compared multiple strategies for rapid TB diagnosis:sputum smear-microscopy; sputum Xpert; smear-microscopy combined with LF-LAM; and Xpert combined with LF-LAM. Primary outcomes were the costs and DALY's averted for each algorithm. Cost-effectiveness was represented using incremental cost-effectiveness ratios (ICER). Results: Compared with an algorithm of Xpert testing alone, the combination of Xpert with LF-LAM was considered highly cost-effective (ICER $57/DALY-averted) at a willingness to pay threshold of Ugandan GDP per capita. Addition of urine LF-LAM testing to smear-microscopy was a less effective strategy than Xpert replacement of smear-microscopy, but was less costly and also considered highly cost-effective (ICER $33 per DALY-averted) compared with continued usage of smear-microscopy alone. Cost-effectiveness of the Xpert plus LF-LAM algorithm was most influenced by HIV/ART costs and life-expectancy of patients after TB treatment. Conclusion: The addition of urinary LF-LAM to TB diagnostic algorithms for HIVinfected individuals is highly cost-effective compared with usage of either sputum smear-microscopy or Xpert alone.

Original languageEnglish (US)
Pages (from-to)2883-2892
Number of pages10
JournalAIDS
Volume27
Issue number18
DOIs
StatePublished - Nov 28 2013

Fingerprint

Uganda
Cost-Benefit Analysis
Tuberculosis
HIV
Microscopy
Costs and Cost Analysis
Sputum
lipoarabinomannan
Decision Support Techniques
Health Services Needs and Demand
Life Expectancy
Signs and Symptoms
Urine

Keywords

  • Cost-effectiveness
  • HIV
  • Lipoarabinomannan
  • Xpert

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases
  • Medicine(all)

Cite this

Cost-effectiveness of novel algorithms for rapid diagnosis of tuberculosis in HIV-infected individuals in Uganda. / Shah, Maunank; Dowdy, David Wesley; Joloba, Moses; Ssengooba, Willy; Manabe, Yukari C; Ellner, Jerrold; Dorman, Susan E.

In: AIDS, Vol. 27, No. 18, 28.11.2013, p. 2883-2892.

Research output: Contribution to journalArticle

Shah, Maunank ; Dowdy, David Wesley ; Joloba, Moses ; Ssengooba, Willy ; Manabe, Yukari C ; Ellner, Jerrold ; Dorman, Susan E. / Cost-effectiveness of novel algorithms for rapid diagnosis of tuberculosis in HIV-infected individuals in Uganda. In: AIDS. 2013 ; Vol. 27, No. 18. pp. 2883-2892.
@article{7af2c8e436f849b591f29a78f60df744,
title = "Cost-effectiveness of novel algorithms for rapid diagnosis of tuberculosis in HIV-infected individuals in Uganda",
abstract = "Objective: Xpert MTB/RIF ('Xpert') and urinary lateral-flow lipoarabinomannan (LF-LAM) assays offer rapid tuberculosis (TB) diagnosis. This study evaluated the cost-effectiveness of novel diagnostic algorithms utilizing combinations of Xpert and LF-LAM for the detection of active TB among people living with HIV. Design: Cost-effectiveness analysis using data from a comparative study of LF-LAM and Xpert, with a target population of HIV-infected individuals with signs/symptoms of TB in Uganda. Methods: A decision-analysis model compared multiple strategies for rapid TB diagnosis:sputum smear-microscopy; sputum Xpert; smear-microscopy combined with LF-LAM; and Xpert combined with LF-LAM. Primary outcomes were the costs and DALY's averted for each algorithm. Cost-effectiveness was represented using incremental cost-effectiveness ratios (ICER). Results: Compared with an algorithm of Xpert testing alone, the combination of Xpert with LF-LAM was considered highly cost-effective (ICER $57/DALY-averted) at a willingness to pay threshold of Ugandan GDP per capita. Addition of urine LF-LAM testing to smear-microscopy was a less effective strategy than Xpert replacement of smear-microscopy, but was less costly and also considered highly cost-effective (ICER $33 per DALY-averted) compared with continued usage of smear-microscopy alone. Cost-effectiveness of the Xpert plus LF-LAM algorithm was most influenced by HIV/ART costs and life-expectancy of patients after TB treatment. Conclusion: The addition of urinary LF-LAM to TB diagnostic algorithms for HIVinfected individuals is highly cost-effective compared with usage of either sputum smear-microscopy or Xpert alone.",
keywords = "Cost-effectiveness, HIV, Lipoarabinomannan, Xpert",
author = "Maunank Shah and Dowdy, {David Wesley} and Moses Joloba and Willy Ssengooba and Manabe, {Yukari C} and Jerrold Ellner and Dorman, {Susan E.}",
year = "2013",
month = "11",
day = "28",
doi = "10.1097/QAD.0000000000000008",
language = "English (US)",
volume = "27",
pages = "2883--2892",
journal = "AIDS",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "18",

}

TY - JOUR

T1 - Cost-effectiveness of novel algorithms for rapid diagnosis of tuberculosis in HIV-infected individuals in Uganda

AU - Shah, Maunank

AU - Dowdy, David Wesley

AU - Joloba, Moses

AU - Ssengooba, Willy

AU - Manabe, Yukari C

AU - Ellner, Jerrold

AU - Dorman, Susan E.

PY - 2013/11/28

Y1 - 2013/11/28

N2 - Objective: Xpert MTB/RIF ('Xpert') and urinary lateral-flow lipoarabinomannan (LF-LAM) assays offer rapid tuberculosis (TB) diagnosis. This study evaluated the cost-effectiveness of novel diagnostic algorithms utilizing combinations of Xpert and LF-LAM for the detection of active TB among people living with HIV. Design: Cost-effectiveness analysis using data from a comparative study of LF-LAM and Xpert, with a target population of HIV-infected individuals with signs/symptoms of TB in Uganda. Methods: A decision-analysis model compared multiple strategies for rapid TB diagnosis:sputum smear-microscopy; sputum Xpert; smear-microscopy combined with LF-LAM; and Xpert combined with LF-LAM. Primary outcomes were the costs and DALY's averted for each algorithm. Cost-effectiveness was represented using incremental cost-effectiveness ratios (ICER). Results: Compared with an algorithm of Xpert testing alone, the combination of Xpert with LF-LAM was considered highly cost-effective (ICER $57/DALY-averted) at a willingness to pay threshold of Ugandan GDP per capita. Addition of urine LF-LAM testing to smear-microscopy was a less effective strategy than Xpert replacement of smear-microscopy, but was less costly and also considered highly cost-effective (ICER $33 per DALY-averted) compared with continued usage of smear-microscopy alone. Cost-effectiveness of the Xpert plus LF-LAM algorithm was most influenced by HIV/ART costs and life-expectancy of patients after TB treatment. Conclusion: The addition of urinary LF-LAM to TB diagnostic algorithms for HIVinfected individuals is highly cost-effective compared with usage of either sputum smear-microscopy or Xpert alone.

AB - Objective: Xpert MTB/RIF ('Xpert') and urinary lateral-flow lipoarabinomannan (LF-LAM) assays offer rapid tuberculosis (TB) diagnosis. This study evaluated the cost-effectiveness of novel diagnostic algorithms utilizing combinations of Xpert and LF-LAM for the detection of active TB among people living with HIV. Design: Cost-effectiveness analysis using data from a comparative study of LF-LAM and Xpert, with a target population of HIV-infected individuals with signs/symptoms of TB in Uganda. Methods: A decision-analysis model compared multiple strategies for rapid TB diagnosis:sputum smear-microscopy; sputum Xpert; smear-microscopy combined with LF-LAM; and Xpert combined with LF-LAM. Primary outcomes were the costs and DALY's averted for each algorithm. Cost-effectiveness was represented using incremental cost-effectiveness ratios (ICER). Results: Compared with an algorithm of Xpert testing alone, the combination of Xpert with LF-LAM was considered highly cost-effective (ICER $57/DALY-averted) at a willingness to pay threshold of Ugandan GDP per capita. Addition of urine LF-LAM testing to smear-microscopy was a less effective strategy than Xpert replacement of smear-microscopy, but was less costly and also considered highly cost-effective (ICER $33 per DALY-averted) compared with continued usage of smear-microscopy alone. Cost-effectiveness of the Xpert plus LF-LAM algorithm was most influenced by HIV/ART costs and life-expectancy of patients after TB treatment. Conclusion: The addition of urinary LF-LAM to TB diagnostic algorithms for HIVinfected individuals is highly cost-effective compared with usage of either sputum smear-microscopy or Xpert alone.

KW - Cost-effectiveness

KW - HIV

KW - Lipoarabinomannan

KW - Xpert

UR - http://www.scopus.com/inward/record.url?scp=84888265566&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84888265566&partnerID=8YFLogxK

U2 - 10.1097/QAD.0000000000000008

DO - 10.1097/QAD.0000000000000008

M3 - Article

C2 - 25119690

AN - SCOPUS:84888265566

VL - 27

SP - 2883

EP - 2892

JO - AIDS

JF - AIDS

SN - 0269-9370

IS - 18

ER -