ABSTRACT
Abstract INTRODUCTION: The present study sought to assess the mean and activity based cost (ABC) of the laboratory diagnosis for tuberculosis through the application of conventional and molecular techniques-Xpert®MTB/RIF and Genotype®MTBDRplus-in a tertiary referral hospital in Brazil. METHODS: The mean cost and ABC formed the basis for the cost analysis of the TB laboratory diagnosis. RESULTS: The mean cost and ABC were US$ 4.00 and US$ 3.24, respectively, for a bacilloscopy; US$ 6.73 and US$ 5.27 for a Lowenstein-Jensen (LJ) culture; US$ 105.42 and US$ 76.56 for a drug sensitivity test (DST)-proportions method (PM) in LJ; US$ 148.45 and US$ 136.80 for a DST-BACTECTM MGITTM 960 system; US$ 11.53 and US$ 9.89 for an Xpert®MTB/RIF; and US$ 84.21 and US$ 48.38 for a Genotype®MTBDRplus. CONCLUSIONS: The mean cost and ABC proved to be good decision-making parameters in the diagnosis of TB and MDR-TB. The effective implementation of algorithms will depend on the conditions at each location.
Subject(s)
Humans , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/economics , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/economics , Costs and Cost Analysis/statistics & numerical data , Mycobacterium tuberculosis/genetics , Brazil , Sensitivity and Specificity , Tertiary Care Centers , Genotype , Mycobacterium tuberculosis/isolation & purificationABSTRACT
Abstract INTRODUCTION: Rapid and accurate tuberculosis detection is critical for improving patient diagnosis and decreasing tuberculosis transmission. Molecular assays can significantly increase laboratory costs; therefore, the average time and economic impact should be evaluated before implementing a new technology. The aim of this study was to evaluate the cost and average turnaround time of smear microscopy and Xpert assay at a university hospital. METHODS: The turnaround time and cost of the laboratory diagnosis of tuberculosis were calculated based on the mean cost and activity based costing (ABC). RESULTS: The average turnaround time for smear microscopy was 16.6 hours while that for Xpert was 24.1 hours. The Xpert had a mean cost of USD 17.37 with an ABC of USD 10.86, while smear microscopy had a mean cost of USD 13.31 with an ABC of USD 6.01. The sensitivity of smear microscopy was 42.9% and its specificity was 99.1%, while the Xpert assay had a sensitivity of 100% and a specificity of 96.7%. CONCLUSIONS: The Xpert assay has high accuracy; however, the turnaround time and cost of smear microscopy were lower than those of Xpert.
Subject(s)
Humans , Tuberculosis, Pulmonary/diagnosis , Biological Assay/economics , Pathology, Molecular/economics , Tuberculosis , Tuberculosis, Pulmonary/economics , Biological Assay/methods , Sensitivity and Specificity , Costs and Cost Analysis , Pathology, Molecular/methods , Microscopy , Mycobacterium tuberculosisABSTRACT
Resumo: O objetivo do estudo foi estimar o impacto orçamentário do GeneXpert MTB/RIF para o diagnóstico da tuberculose sob a perspectiva do Programa Nacional de Controle da Tuberculose, valendo-se de um modelo estático apoiado no método epidemiológico entre 2013 e 2017. Comparou-se um teste Xpert MTB/RIF com duas baciloscopias diagnósticas. Utilizaram-se dados epidemiológicos, populacionais, de custos, a taxa de câmbio e bases de dados do Sistema Único de Saúde. Foi realizada análise de sensibilidade por cenários. A incorporação do GeneXpert MTB/RIF demandaria um montante de R$ 147 milhões em cinco anos e representaria um impacto de 23% a 26% nos dois primeiros anos, e de cerca de 11% entre 2015 e 2017. Os resultados podem apoiar os gestores brasileiros e dos países latino-americanos no planejamento e gestão na sua decisão de incorporação da tecnologia.
Abstract: The study aimed to estimate the budget impact of GeneXpert MTB/RIF for diagnosis of tuberculosis from the perspective of the Brazilian National Program for Tuberculosis Control, drawing on a static model using the epidemiological method, from 2013 to 2017. GeneXpert MTB/RIF was compared with two diagnostic sputum smear tests. The study used epidemiological, population, and cost data, exchange rates, and databases from the Brazilian Unified National Health System. Sensitivity analysis of scenarios was performed. Incorporation of GeneXpert MTB/RIF would cost BRL 147 million (roughly USD 45 million) in five years and would have an impact of 23 to 26% in the first two years and some 11% between 2015 and 2017. The results can support Brazilian and other Latin American health administrators in planning and managing the decision on incorporating the technology.
Resumen: El objetivo del estudio fue estimar el impacto presupuestario del GeneXpert MTB/RIF para el diagnóstico de la tuberculosis, desde la perspectiva del Programa Nacional de Control de la Tuberculosis de Brasil, valiéndose de un modelo estático, apoyado en el método epidemiológico entre 2013 y 2017. Se comparó un test Xpert MTB/RIF con dos baciloscopias diagnósticas. Se utilizaron datos epidemiológicos, poblacionales, de costes, la tasa de cambio y bases de datos del Sistema Único de Salud. Se realizó un análisis de sensibilidad por escenarios. La incorporación del GeneXpert MTB/RIF demandaría un montante de R$ 147 millones en cinco años y representaría un impacto de 23 a 26% durante los dos primeros años, y de cerca de un 11% entre 2015 y 2017. Los resultados pueden apoyar a los gestores brasileiros y de los países latinoamericanos en la planificación y gestión a la hora de decidir incorporar este tipo de tecnología.
Subject(s)
Humans , Tuberculosis, Pulmonary/diagnosis , Budgets , Molecular Diagnostic Techniques/economics , Mycobacterium tuberculosis/genetics , Tuberculosis, Pulmonary/economics , Brazil , Sensitivity and Specificity , Molecular Diagnostic Techniques/methods , National Health ProgramsABSTRACT
Objetivo. Estimar la relación de costo-efectividad del tratamiento de corta duración bajoobservación directa (DOTS), comparándolo con una variación de dicho tratamiento, que incluyeun mayor seguimiento a los convivientes residenciales de los pacientes (DOTS-R) parael tratamiento de tuberculosis (TB).Métodos. Tomando una perspectiva social que incluye los costos para las institucionesde salud, para los pacientes y sus familiares, y para otras entidades que contribuyen a hacerefectiva la operación del programa, se evaluaron los costos incurridos con cada una de las dosestrategias y se estimaron razones costo-efectividad adoptando las medidas de efecto usadas porlos programas de control. La estimación de los costos de cada una de las dos estrategias incluyelos correspondientes a las instituciones de salud que administran el tratamiento, los pacientesy sus familiares, y los de la secretaría de salud que gestiona los programas de salud pública anivel municipal. Con base en estos costos y el número de casos curados y tratamientos terminadoscomo medidas de resultado de cada una de las estrategias evaluadas, se calcularon lasrazones costo-efectividad y costo incremental.Resultados. El DOTS-R se halló más costo-efectivo para lograr tratamientos exitosos queel DOTS. El DOTS-R registró costos de entre US$ 1 122,4 y US$ 1 152,7 por caso curado,comparados con valores de entre US$ 1 137,0 y US$ 1 494,3 correspondientes al DOTS. Laproporción de casos tratados con éxito fue mayor con DOTS-R que con DOTS.Conclusiones. El DOTS-R es una alternativa costo-efectiva promisoria para mejorar elcontrol de la TB en sitios endémicos. Se recomienda a las autoridades del sector salud incorporaren su gestión institucional del programa contra la TB, acciones de seguimiento de losconvivientes de pacientes, con la participación del personal de salud y los recursos físicos yfinancieros que apoyan actualmente dicho programa.
Objective. Estimate the cost-effectiveness ratio of the directly observed treatmentshort course (DOTS) for treatment of tuberculosis (TB), comparing it to a variation ofthis treatment that includes increased home-based guardian monitoring of patients(DOTS-R).Methods. Taking a social perspective that includes the costs for the healthinstitutions, the patients, and their family members, and for other entities thatcontribute to making operation of the program effective, the costs incurred with eachof the two strategies were evaluated and the cost-effectiveness ratios were estimatedadopting the measures of effect used by the control programs. The estimate of the costof each of the two strategies includes the cost to the health institutions that administertreatment, the patients and their family members, and the cost to the Ministry ofHealth that manages public health programs on the municipal level. Based on thesecosts and the number of cases cured and treatments completed as outcome measuresof each of the strategies evaluated, the cost-effectiveness ratio and incremental costwere calculated.Results. The DOTS-R was found to be more cost-effective for achievement ofsuccessful treatments than the DOTS. The DOTS-R recorded costs of US$ 1 122.40 toUS$ 1 152.70 for each case cured compared to values of US$ 1 137.00 to US$ 1 494.30for the DOTS. The percentage of cases treated successfully was higher with DOTS-Rthan with DOTS.Conclusions. The DOTS-R is a promising cost-effective alternative for improvedcontrol of TB in endemic areas. It is recommended that the health authorities includehome-based guardian monitoring of patients in their institutional management of theTB program, with the participation of health workers and the physical and financialresources that currently support this program.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Case Management/economics , Health Care Costs/statistics & numerical data , Health Expenditures/statistics & numerical data , Home Care Services, Hospital-Based/economics , House Calls/economics , Tuberculosis, Pulmonary/economics , Antitubercular Agents/economics , Antitubercular Agents/therapeutic use , Case Management/organization & administration , Case Management/statistics & numerical data , Colombia , Cost of Illness , Cost-Benefit Analysis , Home Care Services, Hospital-Based/organization & administration , Home Care Services, Hospital-Based/standards , Hospitalization/economics , Patient Education as Topic/economics , Patient Education as Topic/methods , Program Evaluation , Telephone/economics , Travel/economics , Tuberculosis, Pulmonary/drug therapySubject(s)
Communicable Disease Control/economics , Communicable Disease Control/methods , Communicable Disease Control/trends , Health Policy/economics , Health Policy/trends , Humans , India , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/economics , Tuberculosis, Pulmonary/prevention & controlABSTRACT
This study aimed to evaluate the epidemiological status of Tuberculosis regarding to the socioeconomic characteristics of São José do Rio Preto between 1998 and 2004. Indexes estimated for 432 urban census tracts from the demographic census of 2000, sorted systematically according to the values of socioeconomic factors and grouped into quartiles were taken into account. The socioeconomic characterization was outlined based on Schooling, Income, and Number of Residents. The incidence rates were considered for 1998, 1999, 2003, and 2004. The socioeconomic factor accounted for 87 percent of the total variation. The disease prevalence is higher in the poorest areas. The incidence rate and the risk of being infected by TB in the poorest areas declined in 2003 and 2004. The results confirm that TB is determined by the population's living conditions in the city studied. It strengthens the relevance of understanding the TB conditional social factors to transform the worrisome scenario in which this population is inserted.
O objetivo foi analisar a situação epidemiológica da tuberculose (TB) em relação às características socioeconômicas de São José do Rio Preto, SP, entre 1998 e 2004. Considerou-se indicadores estimados para 432 setores censitários da área urbana, ano censitário 2000, ordenados segundo valores do fator socioeconômico e agrupados em quartis. A caracterização socioeconômica foi delineada com base em escolaridade, renda e número de moradores. Os coeficientes de incidência foram calculados para 1998, 1999, 2003 e 2004. O fator socioeconômico foi responsável por 87 por cento da variação total. A doença incide com mais força nas áreas mais pobres. Em 2003 e 2004 diminuíram a taxa de incidência e o risco de adoecer por tuberculose nas áreas mais pobres. Os resultados confirmam a determinação da tuberculose, no município estudado, pelas condições de vida da população, fortalecendo a importância da compreensão dos condicionantes sociais da TB para transformar o cenário preocupante em que está inserida.
El objetivo fue analizar la situación epidemiológica de la Tuberculosis en relación a las características socioeconómicas de São José do Rio Preto entre 1998 e 2004. Fueron considerados indicadores estimados para 432 sectores censales del área urbana, año censal 2000, ordenados según valores del factor socioeconómico, agrupados en quartiles. Caracterización socioeconómica delineada por la Escolaridad, Renta y Número de personas. Coeficientes de incidencia fueron calculados para 1998, 1999, 2003 y 2004. El factor socioeconómico fue responsable por el 87 por ciento de la variación total. La enfermedad incide con más fuerza en las áreas más pobres. En 2003 y 2004, disminuyó la incidencia y el riesgo de enfermar por Tuberculosis en las áreas más pobres. Resultados confirman la determinación de la Tuberculosis, en el municipio, por las condiciones de vida de la población, fortaleciendo la importancia de la comprensión de los condicionantes sociales de la TB para transformar el escenario preocupante en que está insertada.
Subject(s)
Aged , Female , Humans , Male , Poverty , Tuberculosis, Pulmonary/economics , Tuberculosis, Pulmonary/epidemiology , Urban Health/statistics & numerical data , Brazil/epidemiology , Censuses , Health Status Disparities , Poverty Areas , Prevalence , Psychology , Socioeconomic FactorsABSTRACT
La muestra lo constituye los 18 casos de T.B.C. pulmonar que abandonan su tratamiento de un universo de los casos nuevos diagnósticados en 1982 en el Centro de Salud Buenos Aires de Villa, Area Hospitalaria # 8 y que representa el 16 por ciento. En la presente investigación consideramos como unidad de análisis los factores que determinaron el abandono del tratamiento, para ello se trata de encontrar una explicación causal de esta situación, sistematizando la información requerida en dos elementos de análisis o variables de primer orden: 1. Relaciones con el enfermo.2. Relaciones con la organización y funcionamiento del sistema de servicios de salud. Estas variables han sido separadas en variables de tercer orden para su mejor análisis además los indicadores respectivos