Serological Testing Versus Other Strategies for Diagnosis of Active Tuberculosis in India A Cost-Effectiveness Analysis 英文参考文献.docVIP

下载本文档

4
0
约4.74万字
约 10页
2017-05-13 发布于上海
举报
版权申诉

Serological Testing Versus Other Strategies for Diagnosis of Active Tuberculosis in India A Cost-Effectiveness Analysis 英文参考文献.doc

1、本文档共10页，可阅读全部内容。
2、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。
3、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击这里二次下载。
4、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
5、该文档为VIP文档，如果想要下载，成为VIP会员后，下载免费。
6、成为VIP后，下载本文档将扣除1次下载权益。下载后，不支持退款、换文档。如有疑问请联系我们。
7、成为VIP后，您将拥有八大权益，权益包括：VIP文档下载权益、阅读免打扰、文档格式转换、高级专利检索、专属身份标志、高级客服、多端互通、版权登记。
8、VIP文档为合作方或网友上传，每下载1次，网站将根据用户上传文档的质量评分、类型等，对文档贡献者给予高额补贴、流量扶持。如果你也想贡献VIP文档。上传文档

SerologicalTestingVersusOtherStrategiesforDiagnosis ofActiveTuberculosisinIndia:ACost-Effectiveness Analysis DavidW.Dowdy1,KarenR.Steingart2,MadhukarPai3* 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, 2Department of Health Services, UniversityofWashingtonSchoolofPublicHealth,Seattle,Washington,UnitedStatesofAmerica,3DepartmentofEpidemiology,Biostatistics,andOccupationalHealth, McGillUniversityMontrealChestInstitute,Montreal,Canada Abstract Background: Undiagnosed and misdiagnosed tuberculosis (TB) drives the epidemic in India. Serological (antibody detection)TBtestsarenotrecommendedbyanyagency,butwidelyusedinmanycountries,includingtheIndianprivate sector.Thecostandimpactofusingserologycomparedwithotherdiagnostictechniquesisunknown. MethodsandFindings:TakingapatientcohortconservativelyequaltotheannualnumberofserologicaltestsdoneinIndia (1.5millionadultssuspectedofhavingactiveTB),weuseddecisionanalysistoestimatecostsandeffectivenessofsputum smearmicroscopy(US$3.62fortwosmears),microscopyplusautomatedliquidculture(mycobacteriumgrowthindicator tube[MGIT],US$20/test),andserologicaltesting(anda-tbELISA,US$20/test).Dataontestaccuracyandcostswereobtained frompublishedliterature.WeadoptedtheperspectiveoftheIndianTBcontrolsectorandananalysisframeof1year.Our primary outcome was the incremental cost per disability-adjusted life year (DALY) averted. We performed one-way sensitivityanalysisonallmodelparameters,withmultiwaysensitivityanalysisonvariablestowhichthemodelwasmost sensitive.If used instead of sputum microscopy, serology generated an estimated 14,000 more TB diagnoses, but also 121,000morefalse-positivediagnoses,102,000fewerDALYsaverted,and32,000moresecondaryTBcasesthanmicroscopy, at approximately four times the incremental cost (US$47.5 million versus US$11.9 million). When added to high-quality sputumsmears,MGITculturewasestimatedtoavert130,000incrementalDALYsatanincrementalcostofUS$213per