Impacto económico de la introducción de una técnica de detección precoz de Mycobacterium tuberculosis complex en muestras clínicas de un hospital español / Economic impact of the introduction of a technique for early detection of mycobacterium tuberculosis complex in clinical samples in a Spanih hospital

Fundamentos: La tuberculosis (TB) continúa siendo un problema importante de salud pública a nivel mundial. El objetivo del estudio fue estimar el impacto económico y asistencial de la introducción de Xpert MTB/RIF® (Xpert), técnica de diagnóstico rápido de TB. Métodos: Se estimó el ahorro en base a la reducción del tiempo de ingreso por TB al evitar los falsos negativos (FN) y falsos positivos (FP) de la baciloscopia que se habrían detectado por Xpert en el periodo 2008-2012. El análisis y cálculo de gastos se hizo sumando el coste de los FN (estancias más pruebas especiales y aislamiento respiratorio) y los FP (tratamiento antituberculoso, consultas sucesivas, analíticas y controles microbiológicos). Resultados: Durante los 5 años de estudio se detectaron 19 FP y 22 FN. Xpert habría detectado los 19 FP y 15 FN. El gasto mínimo estimado para los FP fue de 3.217 euros (tratamiento, consultas sucesivas, analíticas y controles microbiológicos), mientras que cada FN supuso una prolongación de una estancia media de 7 días (59.012 euros), traducidos ambos en un coste total de 62.229 euros. Con una inversión inicial de 16.250 euros (50 casos con elevada sospecha de TB a 65 euros/prueba) el hospital habría ahorrado un global de 45.979 euros en 5 años. Conclusión: La introducción de Xpert supondría un ahorro económico para el hospital y una mejora en la calidad asistencial, evitando estancias y tratamientos innecesarios(AU)

Background: Tuberculosis (TB) remains an important public health problem worldwide. Our objective was to estimate the economic and health care impact of the introduction of an early diagnosis tecnique of TB, the Xpert MTB/RIF® assay (Xpert). Methods: The savings was estimated on the basis of reduction in the time of TB hospitalization at avoid the false-negative (FN) and false-positive (FP) TB cases diagnosed by auramine staining that could have been detected by Xpert between 2008-2012 in our hospital. The costs analysis was made by adding the cost arising from FN (hospitalization, special tests and equipment for respiratory isolation) and FP (TB treatment, successive medical consultations, analytical and microbiological controls). Results: We detected 19 FP and 22 FN during the 5-year study. Xpert would have detected 19 FP and 15 FN. It was estimated a minimum cost of 3217 euros per FP (treatment, successive medical consultations, analytical and microbiological controls), while each FN has required an extension of hospitalization from 7 days on average (62229 euros), both translated into a global cost of 62229 euros. After an initial investment of 16250 euros (50 cases with high suspicion of TB at 65 euros/test), the hospital would have saved 45979 euros overall in five years. Conclusions: The introduction of Xpert would improve the quality of health care of patients, avoiding both unnecessary hospitalizations and treatments. Also, Xpert carries a saving for our hospital(AU)

The cost of medical management of pulmonary nontuberculous mycobacterial disease in Ontario, Canada.

Treatment of pulmonary nontuberculous mycobacterial (NTM) infection is complex, requiring multiple antibiotics and a prolonged treatment course. We determined the monthly cost of treating patients with pulmonary NTM infections in our clinic, a tertiary care centre in Toronto, Ontario, Canada. We reviewed records of a single clinic at the University Health Network (Toronto) for all patients with pulmonary NTM isolates. Pharmacological and nonpharmacological treatment costs were calculated using a number of Canadian references. 172 patients were reviewed, 91 of whom were treated pharmacologically. The median total duration and cost per treated patient were 14 months (interquartile range (IQR) 9-23 months) and CAD 4,916 (IQR CAD 2,934-9,063), respectively. Median monthly drug treatment cost was CAD 321 (IQR CAD 254-458) for all patients, CAD 289 (IQR CAD 237-341) for patients receiving exclusively oral antibiotics and CAD 1,161 (IQR CAD 795-1,646) for patients whose treatment included i.v. antibiotics. The most costly oral regiment consisted of a fluroquinolone, macrolide and rifampin. In multivariable analysis, Mycobacterium abscessus infection, i.v. therapy and Mycobacterium xenopi infection were all associated with increased monthly treatment costs. The direct medical costs of NTM infections are substantial. Less expensive alternative therapies might be most helpful for M. abscessus infection and when i.v. antibiotics are deemed necessary.