4.6 Article

Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis

期刊

BMJ OPEN
卷 12, 期 7, 页码 -

出版社

BMJ PUBLISHING GROUP
DOI: 10.1136/bmjopen-2021-058388

关键词

health economics; tuberculosis; epidemiology; health economics; infectious diseases; paediatric infectious disease & immunisation

资金

  1. TB Modelling and Analysis Consortium (Bill & Melinda Gates Foundation) [OPP1084276]
  2. UK Medical Research Council [MR/P022081/1]
  3. European Union

向作者/读者索取更多资源

Adding the SOS stool method to the national algorithms for diagnosing tuberculosis in children is likely to be cost-effective in both Ethiopia and Indonesia. The intervention increases the sensitivity of TB diagnosis and reduces mortality rate. It also reduces the number of referrals to higher levels of care and increases the number of children initiating anti-TB treatment at primary healthcare level.
Objectives The WHO currently recommends stool testing using GeneXpert MTB/Rif (Xpert) for the diagnosis of paediatric tuberculosis (TB). The simple one-step (SOS) stool method enables processing for Xpert testing at the primary healthcare (PHC) level. We modelled the impact and cost-effectiveness of implementing the SOS stool method at PHC for the diagnosis of paediatric TB in Ethiopia and Indonesia, compared with the standard of care. Setting All children (age <15 years) presenting with presumptive TB at primary healthcare or hospital level in Ethiopia and Indonesia. Primary outcome Cost-effectiveness estimated as incremental costs compared with incremental disability-adjusted life-years (DALYs) saved. Methods Decision tree modelling was used to represent pathways of patient care and referral. We based model parameters on ongoing studies and surveillance, systematic literature review, and expert opinion. We estimated costs using data available publicly and obtained through in-country expert consultations. Health outcomes were based on modelled mortality and discounted life-years lost. Results The intervention increased the sensitivity of TB diagnosis by 19-25% in both countries leading to a 14-20% relative reduction in mortality. Under the intervention, fewer children seeking care at PHC were referred (or self-referred) to higher levels of care; the number of children initiating anti-TB treatment (ATT) increased by 18-25%; and more children (85%) initiated ATT at PHC level. Costs increased under the intervention compared with a base case using smear microscopy in the standard of care resulting in incremental cost-effectiveness ratios of US$132 and US$94 per DALY averted in Ethiopia and Indonesia, respectively. At a cost-effectiveness threshold of 0.5xgross domestic product per capita, the projected probability of the intervention being cost-effective in Ethiopia and Indonesia was 87% and 96%, respectively. The intervention remained cost-effective under sensitivity analyses. Conclusions The addition of the SOS stool method to national algorithms for diagnosing TB in children is likely to be cost-effective in both Ethiopia and Indonesia.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.6
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据