@article {Dunbar:2017:1027-3719:1026,
title = "High laboratory cost predicted per tuberculosis case diagnosed with increased case finding without a triage strategy",
journal = "The International Journal of Tuberculosis and Lung Disease",
parent_itemid = "infobike://iuatld/ijtld",
publishercode ="iuatld",
year = "2017",
volume = "21",
number = "9",
publication date ="2017-09-01T00:00:00",
pages = "1026-1034",
itemtype = "ARTICLE",
issn = "1027-3719",
eissn = "1815-7920",
url = "https://www.ingentaconnect.com/content/iuatld/ijtld/2017/00000021/00000009/art00014",
doi = "doi:10.5588/ijtld.17.0156",
keyword = "operational modelling, TB diagnostic, simulation, diagnostic cost",
author = "Dunbar, R. and Naidoo, P. and Beyers, N. and Langley, I.",
abstract = "SETTING: Cape Town, South Africa.OBJECTIVE: To model the effects of increased case finding and triage strategies on laboratory costs per tuberculosis (TB) case diagnosed.METHODS: We used a validated operational model and published laboratory cost data. We modelled the effect
of varying the proportion with TB among presumptive cases and Xpert cartridge price reductions on cost per TB case and per additional TB case diagnosed in the Xpert-based vs. smear/culture-based algorithms.RESULTS: In our current scenario (18.3% with TB among presumptive cases), the proportion
of cases diagnosed increased by 8.7% (16.7% vs. 15.0%), and the cost per case diagnosed increased by 142% (US$121 vs. US$50). The cost per additional case diagnosed was US$986. This would increase to US$1619 if the proportion with TB among presumptive cases was
10.6%. At 25.930.8% of TB prevalence among presumptive cases and a 50% reduction in Xpert cartridge price, the cost per TB case diagnosed would range from US$50 to US$59 (comparable to the US$48.77 found in routine practice with smear/culture).CONCLUSION: The
operational model illustrates the effect of increased case finding on laboratory costs per TB case diagnosed. Unless triage strategies are identified, the approach will not be sustainable, even if Xpert cartridge prices are reduced.",
}