Cost-utility of lateral-flow urine lipoarabinomannan for tuberculosis diagnosis in HIV-infected African adults

Post Date: 
2013-04-15
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Countries: 
Publication: 
International Journal of Tuberculosis and Lung Disease
Summary: 


Setting: In-patient hospitals in South Africa and Uganda.


Objective: To evaluate the cost-effectiveness of a lateral-flow urine lipoarabinomannan (LAM) test when added to existing strategies for tuberculosis (TB) diagnosis in human immunodeficiency virus infected adults (CD4(+) T-cell counts < 100 cells/l) with symptoms of active TB.


Design: Decision-analytic cost-utility model, with the primary outcome being the incremental cost-effectiveness ratio, expressed in 2010 US dollars per disability-adjusted life year (DALY) averted from the perspective of a public sector TB control program.


Results and Conclusion: For every 1000 patients tested, adding lateral-flow urine LAM generated 80 incremental appropriate anti-tuberculosis treatments and averted 224 DALYs. Estimated cost utility was US$353 per DALY averted (95% uncertainty range $192$1161) in South Africa and $86 per DALY averted (95% uncertainty range $49$239) in Uganda, reflecting the lower treatment costs in Uganda. Cost utility was most sensitive to assay specificity, cost of anti-tuberculosis treatment, life expectancy after TB cure and cohort TB prevalence, but did not rise above $1500 per DALY averted in South Africa under any one-way sensitivity analysis. The probability of acceptability was >99.8% at a per-DALY willingness-to-pay threshold equal to the per capita gross domestic product in South Africa ($7275) and Uganda ($509).

Citation: 
Sun D, Dorman S, Shah M, Manabe Y, Dowdy D. Cost-utility of lateral-flow urine lipoarabinomannan for tuberculosis diagnosis in HIV-infected African adults. IJTLD 2013 April; 17(4):552-8. PMID: 23485389; PMCID: PMC3918209.
Collaborators: 


Johns Hopkins Bloomberg School of Public Health, Baltimore, MD