Journal Article

Cost-Effectiveness Analysis of Introduction of Rapid, Alternative Methods to Identify Multidrug-Resistant Tuberculosis in Middle-Income Countries

Carlos Acuna-Villaorduna, Anna Vassall, German Henostroza, Carlos Seas, Humberto Guerra, Lucy Vasquez, Nora Morcillo, Juan Saravia, Richard O'Brien, Mark D. Perkins, Jane Cunningham, Luis Llanos-Zavalaga and Eduardo Gotuzzo

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 47, issue 4, pages 487-495
Published in print August 2008 | ISSN: 1058-4838
Published online August 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/590010
Cost-Effectiveness Analysis of Introduction of Rapid, Alternative Methods to Identify Multidrug-Resistant Tuberculosis in Middle-Income Countries

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Background. Resistance to commonly used antituberculosis drugs is emerging worldwide. Conventional drug-susceptibility testing (DST) methods are slow and demanding. Alternative, rapid DST methods would permit the early detection of drug resistance and, in turn, arrest tuberculosis transmission.

Methods. A cost-effectiveness analysis of 5 DST methods was performed in the context of a clinical trial that compared rapid with conventional DST methods. The methods under investigation were direct phage-replication assay (FASTPlaque-Response; Biotech), direct amplification and reverse hybridization of the rpoB gene (INNO-LiPA; Innogenetics), indirect colorimetric minimum inhibitory concentration assay (MTT; ICN Biomedicals), and direct proportion method on Löwenstein-Jensen medium. These were compared with the widely used indirect proportion method on Löwenstein-Jensen medium.

Results. All alternative DST methods were found to be cost-effective, compared with other health care interventions. DST methods also generate substantial cost savings in settings of high prevalence of multidrug-resistant tuberculosis. Excluding the effects of transmission, the direct proportion method on Löwenstein-Jensen medium was the most cost-effective alternative DST method for patient groups with prevalences of multidrug-resistant tuberculosis of 2%, 5%, 20%, and 50% (cost in US$2004, $94, $36, $8, and $2 per disability-adjusted life year, respectively).

Conclusion. Alternative, rapid methods for DST are cost-effective and should be considered for use by national tuberculosis programs in middle-income countries.

Journal Article.  4653 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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