Cost utility of lateral-flow urine lipoarabinomannan for tuberculosis diagnosis in HIV-infected African adults.
Int J Tuberc Lung Dis
; 17(4): 552-8, 2013 Apr.
Article
em En
| MEDLINE
| ID: mdl-23485389
ABSTRACT
SETTING:
In-patient hospitals in South Africa and Uganda.OBJECTIVE:
To evaluate the cost-effectiveness of a lateral-flow urine lipoarabinomannan (LAM) test when added to existing strategies for tuberculosis (TB) diagnosis in human immunodeficiency virus infected adults (CD4(+) T-cell counts < 100 cells/l) with symptoms of active TB.DESIGN:
Decision-analytic cost-utility model, with the primary outcome being the incremental cost-effectiveness ratio, expressed in 2010 US dollars per disability-adjusted life year (DALY) averted from the perspective of a public sector TB control program. RESULTS ANDCONCLUSION:
For every 1000 patients tested, adding lateral-flow urine LAM generated 80 incremental appropriate anti-tuberculosis treatments and averted 224 DALYs. Estimated cost utility was US$353 per DALY averted (95% uncertainty range $192$1161) in South Africa and $86 per DALY averted (95% uncertainty range $49$239) in Uganda, reflecting the lower treatment costs in Uganda. Cost utility was most sensitive to assay specificity, cost of anti-tuberculosis treatment, life expectancy after TB cure and cohort TB prevalence, but did not rise above $1500 per DALY averted in South Africa under any one-way sensitivity analysis. The probability of acceptability was >99.8% at a per-DALY willingness-to-pay threshold equal to the per capita gross domestic product in South Africa ($7275) and Uganda ($509).
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Tuberculose
/
Infecções por HIV
/
Lipopolissacarídeos
/
Custos de Cuidados de Saúde
/
Países em Desenvolvimento
/
Coinfecção
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Health_economic_evaluation
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Humans
País como assunto:
Africa
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article