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A costing framework to compare tuberculosis infection tests

OBJECTIVE: To develop a framework to estimate the practical costs incurred from, and programmatic impact related to, tuberculosis (TB) infection testing—tuberculin skin tests (TST) versus interferon gamma release assay (IGRA)—in a densely populated high-burden TB area. METHODS: We developed a seven-...

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Autores principales: Brumwell, Amanda, Tso, Jade, Pingali, Viswanath, Millones, Ana Karina, Jimenez, Judith, Calderon, Roger I, Barreda, Nadia, Lecca, Leonid, Nicholson, Tom, Brooks, Meredith
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689396/
https://www.ncbi.nlm.nih.gov/pubmed/38035732
http://dx.doi.org/10.1136/bmjgh-2023-012297
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author Brumwell, Amanda
Tso, Jade
Pingali, Viswanath
Millones, Ana Karina
Jimenez, Judith
Calderon, Roger I
Barreda, Nadia
Lecca, Leonid
Nicholson, Tom
Brooks, Meredith
author_facet Brumwell, Amanda
Tso, Jade
Pingali, Viswanath
Millones, Ana Karina
Jimenez, Judith
Calderon, Roger I
Barreda, Nadia
Lecca, Leonid
Nicholson, Tom
Brooks, Meredith
author_sort Brumwell, Amanda
collection PubMed
description OBJECTIVE: To develop a framework to estimate the practical costs incurred from, and programmatic impact related to, tuberculosis (TB) infection testing—tuberculin skin tests (TST) versus interferon gamma release assay (IGRA)—in a densely populated high-burden TB area. METHODS: We developed a seven-step framework that can be tailored to individual TB programmes seeking to compare TB infection (TBI) diagnostics to inform decision-making. We present methodology to estimate (1) the prevalence of TBI, (2) true and false positives and negatives for each test, (3) the cost of test administration, (4) the cost of false negatives, (5) the cost of treating all that test positive, (6) the per-test cost incurred due to treatment and misdiagnosis and (7) the threshold at which laboratory infrastructure investments for IGRA are outweighed by system-wide savings incurred due to IGRA utilisation. We then applied this framework in a densely populated, peri-urban district in Lima, Peru with high rates of Bacillus Calmette–Guérin (BCG) vaccination. FINDINGS: The lower sensitivity of TST compared with IGRA is a major cost driver, leading to health system and societal costs due to misdiagnosis. Additionally, patient and staff productivity costs were greater for TST because it requires two patient visits compared with only one for IGRA testing. When the framework was applied to the Lima setting, we estimate that IGRA-associated benefits outweigh infrastructural costs after performing 672 tests. CONCLUSIONS: Given global shortages of TST and concerns about costs of IGRA testing and laboratory capacity building, this costing framework can provide public health officials and TB programmes guidance for decision-making about TBI testing locally. This framework was designed to be adaptable for use in different settings with available data. Diagnostics that increase accuracy or mitigate time to treatment should be thought of as an investment instead of an expenditure.
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spelling pubmed-106893962023-12-02 A costing framework to compare tuberculosis infection tests Brumwell, Amanda Tso, Jade Pingali, Viswanath Millones, Ana Karina Jimenez, Judith Calderon, Roger I Barreda, Nadia Lecca, Leonid Nicholson, Tom Brooks, Meredith BMJ Glob Health Original Research OBJECTIVE: To develop a framework to estimate the practical costs incurred from, and programmatic impact related to, tuberculosis (TB) infection testing—tuberculin skin tests (TST) versus interferon gamma release assay (IGRA)—in a densely populated high-burden TB area. METHODS: We developed a seven-step framework that can be tailored to individual TB programmes seeking to compare TB infection (TBI) diagnostics to inform decision-making. We present methodology to estimate (1) the prevalence of TBI, (2) true and false positives and negatives for each test, (3) the cost of test administration, (4) the cost of false negatives, (5) the cost of treating all that test positive, (6) the per-test cost incurred due to treatment and misdiagnosis and (7) the threshold at which laboratory infrastructure investments for IGRA are outweighed by system-wide savings incurred due to IGRA utilisation. We then applied this framework in a densely populated, peri-urban district in Lima, Peru with high rates of Bacillus Calmette–Guérin (BCG) vaccination. FINDINGS: The lower sensitivity of TST compared with IGRA is a major cost driver, leading to health system and societal costs due to misdiagnosis. Additionally, patient and staff productivity costs were greater for TST because it requires two patient visits compared with only one for IGRA testing. When the framework was applied to the Lima setting, we estimate that IGRA-associated benefits outweigh infrastructural costs after performing 672 tests. CONCLUSIONS: Given global shortages of TST and concerns about costs of IGRA testing and laboratory capacity building, this costing framework can provide public health officials and TB programmes guidance for decision-making about TBI testing locally. This framework was designed to be adaptable for use in different settings with available data. Diagnostics that increase accuracy or mitigate time to treatment should be thought of as an investment instead of an expenditure. BMJ Publishing Group 2023-11-30 /pmc/articles/PMC10689396/ /pubmed/38035732 http://dx.doi.org/10.1136/bmjgh-2023-012297 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Brumwell, Amanda
Tso, Jade
Pingali, Viswanath
Millones, Ana Karina
Jimenez, Judith
Calderon, Roger I
Barreda, Nadia
Lecca, Leonid
Nicholson, Tom
Brooks, Meredith
A costing framework to compare tuberculosis infection tests
title A costing framework to compare tuberculosis infection tests
title_full A costing framework to compare tuberculosis infection tests
title_fullStr A costing framework to compare tuberculosis infection tests
title_full_unstemmed A costing framework to compare tuberculosis infection tests
title_short A costing framework to compare tuberculosis infection tests
title_sort costing framework to compare tuberculosis infection tests
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689396/
https://www.ncbi.nlm.nih.gov/pubmed/38035732
http://dx.doi.org/10.1136/bmjgh-2023-012297
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