| Author | Dowdy, David W. | |
| Author | Lourenco, Maria C. | |
| Author | Cavalcante, Solange C. | |
| Author | Saraceni, Valeria | |
| Author | King, Bonnie | |
| Author | Golub, Jonathan E. | |
| Author | Bishai, David | |
| Author | Durovni, Betina | |
| Author | Chaisson, Richard E. | |
| Author | Dorman, Susan E. | |
| Access date | 2023-05-02T03:49:13Z | |
| Available date | 2023-05-02T03:49:13Z | |
| Document date | 2008 | |
| Citation | DOWDY, David W. et al. Impact and Cost-Effectiveness of Culture for Diagnosis of Tuberculosis in HIV-Infected Brazilian Adults. PLoS ONE, v. 3, n. 12, p. 1-8, e4057, 2008. | en_US |
| ISSN | 1932-6203 | en_US |
| URI | https://www.arca.fiocruz.br/handle/icict/58102 | |
| Sponsorship | This study was supported by the Bill & Melinda Gates Foundation (Grant 19790-01), the Foundation for Innovative New Diagnostics, and the National Institutes of Health (Medical Scientist Training Program Award 5 T32 GMO7309 to DWD; K24 AI 16137 to REC, and K23 AI 51528 to SED). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. | en_US |
| Language | eng | en_US |
| Publisher | Public Library of Science | en_US |
| Rights | open access | en_US |
| Title | Impact and Cost-Effectiveness of Culture for Diagnosis of Tuberculosis in HIV-Infected Brazilian Adults | en_US |
| Type | Article | en_US |
| DOI | 10.1371/journal.pone.0004057 | |
| Abstract | Background: Culture of Mycobacterium tuberculosis currently represents the closest "gold standard" for diagnosis of tuberculosis (TB), but operational data are scant on the impact and cost-effectiveness of TB culture for human immunodeficiency (HIV-) infected individuals in resource-limited settings. Methodology/principal findings: We recorded costs, laboratory results, and dates of initiating TB therapy in a centralized TB culture program for HIV-infected patients in Rio de Janeiro, Brazil, constructing a decision-analysis model to estimate the incremental cost-effectiveness of TB culture from the perspective of a public-sector TB control program. Of 217 TB suspects presenting between January 2006 and March 2008, 33 (15%) had culture-confirmed active tuberculosis; 23 (70%) were smear-negative. Among smear-negative, culture-positive patients, 6 (26%) began TB therapy before culture results were available, 11 (48%) began TB therapy after culture result availability, and 6 (26%) did not begin TB therapy within 180 days of presentation. The cost per negative culture was US$17.52 (solid media)-$23.50 (liquid media). Per 1,000 TB suspects and compared with smear alone, TB culture with solid media would avert an estimated eight TB deaths (95% simulation interval [SI]: 4, 15) and 37 disability-adjusted life years (DALYs) (95% SI: 13, 76), at a cost of $36 (95% SI: $25, $50) per TB suspect or $962 (95% SI: $469, $2642) per DALY averted. Replacing solid media with automated liquid culture would avert one further death (95% SI: -1, 4) and eight DALYs (95% SI: -4, 23) at $2751 per DALY (95% SI: $680, dominated). The cost-effectiveness of TB culture was more sensitive to characteristics of the existing TB diagnostic system than to the accuracy or cost of TB culture. Conclusions/significance: TB culture is potentially effective and cost-effective for HIV-positive patients in resource-constrained settings. Reliable transmission of culture results to patients and integration with existing systems are essential. | en_US |
| Affilliation | Center for Tuberculosis Research. Johns Hopkins University School of Medicine. Baltimore, Maryland, USA / Department of Epidemiology. Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Mycobacteriology Laboratory. Rio de Janeiro, RJ, Brazil. | en_US |
| Affilliation | Municipal Health Secretariat. Communicable Diseases Program. Rio de Janeiro, RJ, Brazil. | en_US |
| Affilliation | Municipal Health Secretariat. Communicable Diseases Program. Rio de Janeiro, RJ, Brazil. | en_US |
| Affilliation | Center for Tuberculosis Research. Johns Hopkins University School of Medicine. Baltimore, Maryland, USA. | en_US |
| Affilliation | Center for Tuberculosis Research. Johns Hopkins University School of Medicine. Baltimore, Maryland, USA / Department of Epidemiology. Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA. | en_US |
| Affilliation | Department of Population and Family Health Sciences. Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA. | en_US |
| Affilliation | Municipal Health Secretariat. Communicable Diseases Program. Rio de Janeiro, RJ, Brazil. | en_US |
| Affilliation | Center for Tuberculosis Research. Johns Hopkins University School of Medicine. Baltimore, Maryland, USA / Department of Epidemiology. Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA / Department of International Health. Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA. | en_US |
| Affilliation | Center for Tuberculosis Research. Johns Hopkins University School of Medicine. Baltimore, Maryland, USA / Department of International Health. Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA. | en_US |
| Subject | Tuberculosis | en_US |
| Subject | HIV-Infected Brazilian Adults | en_US |
| Subject | Diagnosis | en_US |
| e-ISSN | 1932-6203 | |
