Free Content Cost utility of lateral-flow urine lipoarabinomannan for tuberculosis diagnosis in HIV-infected African adults

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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 AND CONCLUSION: 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).

Keywords: HIV; South Africa; Uganda; diagnostic tests and procedures; economic; models; tuberculosis

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.12.0627

Affiliations: 1: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 2: Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA; and Tuberculosis Clinical Diagnostics Research Consortium, Baltimore, Maryland, USA 3: Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA; and Infectious Disease Institute, Kampala, Uganda 4: Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa 5: Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa 6: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA; and Tuberculosis Clinical Diagnostics Research Consortium, Baltimore, Maryland, USA

Publication date: April 1, 2013

More about this publication?
  • 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.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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