Authors: van Cleeff, M.¹; Kivihya-Ndugga, L.²; Githui, W.²; Ng'ang'a, L.³; Kibuga, D.⁴; Odhiambo, J.³; Klatser, P.⁵

Source: The International Journal of Tuberculosis and Lung Disease, Volume 9, Number 8, August 2005 , pp. 877-883(7)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

BACKGROUND: Laboratory services, particularly in large sub-Saharan cities, are overstretched, and it is becoming difficult both for patients and health staff to adhere to the diagnostic procedures for tuberculosis. Alternative techniques would be welcome. The polymerase chain reaction (PCR) has the potential to be cost-effective. We compared the cost-effectiveness of two diagnostic strategies, Ziehl-Neelsen (ZN) on three specimens followed by chest X-ray (CXR), and AMPLICOR MTB PCR on the first specimen only.

METHODS: Three sputum samples were collected from tuberculosis (TB) suspects attending the Rhodes Chest Clinic, Nairobi. All samples were subjected to ZN, PCR and Löwenstein-Jensen culture used as gold standard. CXR was used to diagnose smear-negative TB. Cost analysis included health service and patient costs.

RESULTS: Costs per correctly diagnosed case were US$41 and $67 for ZN and PCR, respectively. When treatment costs were included, including treatment of culture-negative cases, PCR was more cost-effective: $382 vs. $412.

CONCLUSION: PCR may be an alternative in settings with many patients. PCR is patient friendly, CXR is not necessary and, unlike ZN, its performance is hardly affected by the human immunodeficiency virus. PCR can handle large numbers of specimens, with results becoming available on the same day.

Keywords: tuberculosis; diagnosis; smear microscopy; Ziehl-Neelsen; PCR; cost-effectiveness

Document Type: Regular paper

Affiliations: 1: KNCV-Tuberculosis Foundation, The Hague, The Netherlands 2: Centre for Respiratory Diseases Research (CRDR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya 3: Centre for Respiratory Diseases Research (CRDR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya; and Centre for Disease Control and Prevention (CDC), Nairobi, Kenya 4: National Leprosy and Tuberculosis Programme (NLTP), Ministry of Health, Nairobi, Kenya 5: Department of Biomedical Research, KIT (Royal Tropical Institute), Amsterdam, The Netherlands

Publication date: 2005-08-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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