RESUMO
BACKGROUND: With support from the Stop TB Partnership's TB REACH Wave 2 Grant, diagnostic microscopy services for tuberculosis (TB) were upgraded from conventional Ziehl-Neelsen (ZN) based sputum microscopy to light emitting diode technology-based fluorescence microscopy (LED FM) in 200 high-workload microscopy centres in India as a pilot intervention. OBJECTIVE: To evaluate the cost-effectiveness of LED-FM over conventional ZN microscopy to inform further scale-up. METHODS: A decision-tree model was constructed to assess the cost utility of LED FM over ZN microscopy. The results were summarised using incremental cost-effectiveness ratio (ICER); one-way and probabilistic sensitivity analyses were also conducted to address uncertainty within the model. Data were analysed from 200 medical colleges in 2011 and 2012, before and after the introduction of LED microscopes. A full costing analysis was carried out from the perspective of a national TB programme. RESULTS: The ICER was calculated at US$14.64 per disability-adjusted life-year, with an 82% probability of being cost-effective at a willingness-to-pay threshold equivalent to Indian gross domestic product per capita. CONCLUSIONS: LED FM is a cost-effective intervention for detecting TB cases in India at high-workload medical college settings.
Assuntos
Técnicas Bacteriológicas/economia , Países em Desenvolvimento/economia , Custos de Cuidados de Saúde , Microscopia de Fluorescência/economia , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/economia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Árvores de Decisões , Produto Interno Bruto , Humanos , Índia , Modelos Econômicos , Modelos Estatísticos , Projetos Piloto , Valor Preditivo dos Testes , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Escarro/microbiologia , Tuberculose Pulmonar/microbiologia , IncertezaRESUMO
In July 2012, light-emitting diode fluorescence microscopy (LED-FM) replaced conventional light microscopy using Ziehl-Neelsen stain in the detection of sputum-positive pulmonary tuberculosis in 190 microscopy centres of medical colleges operating under India's Revised National Tuberculosis Control Programme. We compared the performance of LED-FM (July-December 2012) to that of conventional microscopy (July-December 2011) across 190 sites. Of 222 658 patients examined using conventional microscopy, 28 042 (12.6%) were smear-positive, while of 224 714 examined using LED-FM, 33 552 (14.9%) were smear-positive, an additional yield of 5251 cases after adjusting for the increase in patients examined. We recommend replacing conventional microscopy with LED-FM in high workload microscopy centres in India.
Dans 190 centres de microscopie des collèges médicaux travaillant dans le Programme Révisé de Lutte contre la Tuberculose en Inde, l'examen microscopique par fluorescence à diode émettrice de lumière (LED-FM) a remplacé l'examen microscopique à lumière conventionnelle utilisant la coloration de Ziehl-Neelsen pour la détection de la tuberculose pulmonaire à frottis positif. Nous avons comparé les performances du LED-FM entre juillet et décembre 2012 à celles de l'examen microscopique conventionnel (juilletdécembre 2011) dans l'ensemble des 190 sites. Les frottis ont été positifs chez 28 042 (12.6%) des 222 658 patients examinés par microscopie conventionnelle comparé à 33 552 (14.9%) des 224 714 patients examinés par LED-FM, un rendement supplémentaire de 5251 cas après ajustement pour l'augmentation du nombre de patients examinés. Nous recommandons le remplacement de l'examen microscopique conventionnel par le LED-FM en Inde dans les centres de microscopie dont la charge de travail est élevée.
En julio del 2012 la microscopia de fluorescencia con diodos electroluminescentes (LED-FM) reemplazó el sistema tradicional de microscopia de luz con tinción de Ziehl-Neelsen en la detección de casos de tuberculosis pulmonar con baciloscopia positiva en 190 centros de microscopia de las facultadas de medicina que funcionan en conformidad con el Programa Nacional Revisado de Control de la Tuberculosis de la India. En el presente artículo se comparó el rendimiento diagnóstico de este nuevo sistema de microscopia (entre julio y diciembre del 2012) con el rendimiento de la microscopia de luz (entre julio y diciembre del 2011) en 190 centros. De los 222 658 pacientes investigados mediante la microscopia de luz, 28 042 (12,6 %) presentaron baciloscopia positiva. De los 224 714 pacientes cuyas muestras se examinaron mediante la LED-FM, 33 552 (14,9 %) obtuvieron una baciloscopia positiva, lo cual corresponde a un incremento del rendimiento de 5251 casos, después de corregir con respecto al aumento del número de pacientes examinados. Se recomienda sustituir el sistema tradicional de microscopia de luz por la LED-FM en los centros con un alto volumen de trabajo en la India.
