Cargando…

Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review

BACKGROUND: Early and accurate diagnosis of tuberculosis is a priority for TB programs globally to initiate treatment early and improve treatment outcomes. Currently, Ziehl–Neelsen (ZN) stain-based microscopy, GeneXpert and Light Emitting Diode-Fluorescence Microscopy (LED-FM) are used for diagnosin...

Descripción completa

Detalles Bibliográficos
Autores principales: Sagili, Karuna D., Muniyandi, Malaisamy, Nilgiriwala, Kayzad Soli, Shringarpure, Kalpita S., Satyanarayana, Srinath, Kirubakaran, Richard, Chadha, Sarabjit S., Tharyan, Prathap
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205591/
https://www.ncbi.nlm.nih.gov/pubmed/30372436
http://dx.doi.org/10.1371/journal.pone.0205233
_version_ 1783366209250525184
author Sagili, Karuna D.
Muniyandi, Malaisamy
Nilgiriwala, Kayzad Soli
Shringarpure, Kalpita S.
Satyanarayana, Srinath
Kirubakaran, Richard
Chadha, Sarabjit S.
Tharyan, Prathap
author_facet Sagili, Karuna D.
Muniyandi, Malaisamy
Nilgiriwala, Kayzad Soli
Shringarpure, Kalpita S.
Satyanarayana, Srinath
Kirubakaran, Richard
Chadha, Sarabjit S.
Tharyan, Prathap
author_sort Sagili, Karuna D.
collection PubMed
description BACKGROUND: Early and accurate diagnosis of tuberculosis is a priority for TB programs globally to initiate treatment early and improve treatment outcomes. Currently, Ziehl–Neelsen (ZN) stain-based microscopy, GeneXpert and Light Emitting Diode-Fluorescence Microscopy (LED-FM) are used for diagnosing pulmonary drug sensitive tuberculosis. Published evidence synthesising the cost-effectiveness of these diagnostic tools is scarce. METHODOLOGY: PubMed, EMBASE and Cost-effectiveness analysis registry were searched for studies that reported on the cost-effectiveness of GeneXpert and LED-FM, compared to ZN microscopy for diagnosing pulmonary TB. Risk of bias was assessed independently by four authors using the Consensus Health Economic Criteria (CHEC) extended checklist. The data variables included the study settings, population, type of intervention, type of comparator, year of study, duration of study, type of study design, costs for the test and the comparator and effectiveness indicators. Incremental cost-effectiveness ratio (ICER) was used for assessing the relative cost-effectiveness in this review. RESULTS: Of the 496 studies identified by the search, thirteen studies were included after removing duplicates and studies that did not fulfil inclusion criteria. Four studies compared LED-FM with ZN and nine studies compared GeneXpert with ZN. Three studies used patient cohorts and eight were modelling studies with hypothetical cohorts used to evaluate cost-effectiveness. All these studies were conducted from a health system perspective, with four studies utilising cost utility analysis. There were considerable variations in costing parameters and effectiveness indicators that precluded meta-analysis. The key findings from the included studies suggest that LED-FM and GeneXpert may be cost effective for pulmonary TB diagnosis from a health system perspective. CONCLUSION: Our review identifies a consistent trend of the cost effectiveness of LED-FM and GeneXpert for pulmonary TB diagnosis in different countries with diverse context of socio-economic condition, HIV burden and geographical distribution. However, all the studies used different parameters to estimate the impact of these tools and this underscores the need for improving the methodological issues related to the conduct and reporting of cost-effectiveness studies.
format Online
Article
Text
id pubmed-6205591
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-62055912018-11-19 Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review Sagili, Karuna D. Muniyandi, Malaisamy Nilgiriwala, Kayzad Soli Shringarpure, Kalpita S. Satyanarayana, Srinath Kirubakaran, Richard Chadha, Sarabjit S. Tharyan, Prathap PLoS One Research Article BACKGROUND: Early and accurate diagnosis of tuberculosis is a priority for TB programs globally to initiate treatment early and improve treatment outcomes. Currently, Ziehl–Neelsen (ZN) stain-based microscopy, GeneXpert and Light Emitting Diode-Fluorescence Microscopy (LED-FM) are used for diagnosing pulmonary drug sensitive tuberculosis. Published evidence synthesising the cost-effectiveness of these diagnostic tools is scarce. METHODOLOGY: PubMed, EMBASE and Cost-effectiveness analysis registry were searched for studies that reported on the cost-effectiveness of GeneXpert and LED-FM, compared to ZN microscopy for diagnosing pulmonary TB. Risk of bias was assessed independently by four authors using the Consensus Health Economic Criteria (CHEC) extended checklist. The data variables included the study settings, population, type of intervention, type of comparator, year of study, duration of study, type of study design, costs for the test and the comparator and effectiveness indicators. Incremental cost-effectiveness ratio (ICER) was used for assessing the relative cost-effectiveness in this review. RESULTS: Of the 496 studies identified by the search, thirteen studies were included after removing duplicates and studies that did not fulfil inclusion criteria. Four studies compared LED-FM with ZN and nine studies compared GeneXpert with ZN. Three studies used patient cohorts and eight were modelling studies with hypothetical cohorts used to evaluate cost-effectiveness. All these studies were conducted from a health system perspective, with four studies utilising cost utility analysis. There were considerable variations in costing parameters and effectiveness indicators that precluded meta-analysis. The key findings from the included studies suggest that LED-FM and GeneXpert may be cost effective for pulmonary TB diagnosis from a health system perspective. CONCLUSION: Our review identifies a consistent trend of the cost effectiveness of LED-FM and GeneXpert for pulmonary TB diagnosis in different countries with diverse context of socio-economic condition, HIV burden and geographical distribution. However, all the studies used different parameters to estimate the impact of these tools and this underscores the need for improving the methodological issues related to the conduct and reporting of cost-effectiveness studies. Public Library of Science 2018-10-29 /pmc/articles/PMC6205591/ /pubmed/30372436 http://dx.doi.org/10.1371/journal.pone.0205233 Text en © 2018 Sagili et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Sagili, Karuna D.
Muniyandi, Malaisamy
Nilgiriwala, Kayzad Soli
Shringarpure, Kalpita S.
Satyanarayana, Srinath
Kirubakaran, Richard
Chadha, Sarabjit S.
Tharyan, Prathap
Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review
title Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review
title_full Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review
title_fullStr Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review
title_full_unstemmed Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review
title_short Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review
title_sort cost-effectiveness of genexpert and led-fm for diagnosis of pulmonary tuberculosis: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205591/
https://www.ncbi.nlm.nih.gov/pubmed/30372436
http://dx.doi.org/10.1371/journal.pone.0205233
work_keys_str_mv AT sagilikarunad costeffectivenessofgenexpertandledfmfordiagnosisofpulmonarytuberculosisasystematicreview
AT muniyandimalaisamy costeffectivenessofgenexpertandledfmfordiagnosisofpulmonarytuberculosisasystematicreview
AT nilgiriwalakayzadsoli costeffectivenessofgenexpertandledfmfordiagnosisofpulmonarytuberculosisasystematicreview
AT shringarpurekalpitas costeffectivenessofgenexpertandledfmfordiagnosisofpulmonarytuberculosisasystematicreview
AT satyanarayanasrinath costeffectivenessofgenexpertandledfmfordiagnosisofpulmonarytuberculosisasystematicreview
AT kirubakaranrichard costeffectivenessofgenexpertandledfmfordiagnosisofpulmonarytuberculosisasystematicreview
AT chadhasarabjits costeffectivenessofgenexpertandledfmfordiagnosisofpulmonarytuberculosisasystematicreview
AT tharyanprathap costeffectivenessofgenexpertandledfmfordiagnosisofpulmonarytuberculosisasystematicreview