COST EFFECTIVENESS ANALYSIS OF MICROSCOPIC OBSERVATION DRUG SUSCEPTIBILITY ASSAY VERSUS GENEXPERT MTB/ RIF IN THE DIAGNOSIS OF PULMONARY TUBERCULOSIS IN HIV PATIENTS
COST EFFECTIVENESS ANALYSIS OF MICROSCOPIC OBSERVATION DRUG SUSCEPTIBILITY ASSAY VERSUS GENEXPERT MTB/ RIF IN THE DIAGNOSIS OF PULMONARY TUBERCULOSIS IN HIV PATIENTS
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Date
2016-12
Authors
OSIGWE, UGOCHUKWU CHINEDU
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Abstract
Patients with HIV experience high mortality and severe morbidity if co-infected with
tuberculosis. This is especially true in countries of sub-Saharan Africa like Nigeria with high
burden of both diseases where diagnostic capacity for TB in HIV positive patients is poor. Early
diagnosis and treatment has been identified as an important strategy to mitigate these effects. A
cost and cost-effectiveness analyses of TB diagnostic strategies to reduce this adverse outcomes
was carried out.
A decision analysis model was developed to estimate the incremental cost, Life years gained, and
cost-effectiveness of 3 TB diagnostic algorithms. The base case scenario was an algorithm
relying on sputum smear, and chest radiography, which was compared to algorithms featuring
newer TB diagnostics (GeneXpert MTB/Rif and MODS). All relevant costs from a National TB
programme perspective using the timeframe of the first 6 months of ART was considered. We
conducted a one-way sensitivity analysis on parameters in the model.
When considering TB diagnosis and treatment costs, the cost per patient was $126.39 for current
practice, $76.96 for the algorithm with Xpert test, and $88.62 for the algorithm with MODS. Life
years gained was 0.9 for all 3 algorithms. The results showed that both new TB diagnostic
methods were more cost effective than base case scenario. The algorithm with Xpert test was
cheapest to achieve similar effectiveness compared with the MODS and base case. Sensitivity
analyses indicated that cost-effectiveness findings were robust.
This study showed that Xpert was cost-effective compared to MODS and base case algorithm.
Thus, these findings provide support for ongoing efforts to expand TB diagnostic capacity with
GeneXpert MTB/Rif.
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Key Words: HIV, tuberculosis, tuberculosis diagnosis, cost, cost- effectiveness, sub-Saharan
Africa, Nigeria
Description
A THESIS SUBMITTED TO THE SCHOOL OF POSTGRADUATE STUDIES,
AHMADU BELLO UNIVERSITY ZARIA, IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE AWARD OF MASTER OF PUBLIC HEALTH (FIELD
EPIDEMIOLOGY) DEGREE
DEPARTMENT OF COMMUNITY MEDICINE,
AHMADU BELLO UNIVERSITY,
ZARIA, NIGERIA
Keywords
COST EFFECTIVENESS ANALYSIS,, MICROSCOPIC,, OBSERVATION DRUG,, SUSCEPTIBILITY,, ASSAY VERSUS GENEXPERT,, MTB/ RIF,, DIAGNOSIS,, PULMONARY TUBERCULOSIS,, HIV PATIENTS