原创力文档serological testing versus other strategies for diagnosis of active tuberculosis in india a cost-effectiveness analysis血清学测试与其他策略的诊断活动性结核病在印度一个成本效益分析.pdfVIP
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serological testing versus other strategies for diagnosis of active tuberculosis in india a cost-effectiveness analysis血清学测试与其他策略的诊断活动性结核病在印度一个成本效益分析
Serological Testing Versus Other Strategies for Diagnosis
of Active Tuberculosis in India: A Cost-Effectiveness
Analysis
1 2 3
David W. Dowdy , Karen R. Steingart , Madhukar Pai *
1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, 2 Department of Health Services,
University of Washington School of Public Health, Seattle, Washington, United States of America, 3 Department of Epidemiology, Biostatistics, and Occupational Health,
McGill University Montreal Chest Institute, Montreal, Canada
Abstract
Background: Undiagnosed and misdiagnosed tuberculosis (TB) drives the epidemic in India. Serological (antibody
detection) TB tests are not recommended by any agency, but widely used in many countries, including the Indian private
sector. The cost and impact of using serology compared with other diagnostic techniques is unknown.
Methods and Findings: Taking a patient cohort conservatively equal to the annual number of serological tests done in India
(1.5 million adults suspected of having active TB), we used decision analysis to estimate costs and effectiveness of sputum
smear microscopy (US$3.62 for two smears), microscopy plus automated liquid culture (mycobacterium growth indicator
tube [MGIT], US$20/test), and serological testing (anda-tb ELISA, US$20/test). Data on test accuracy and costs were obtained
from published literature. We adopted the perspective of the Indian TB control sector and an analysis frame of 1 year. Our
primary outcome was the incremental cost per disability-adjusted life year (DALY) averted. We performed one-way
sensitivity analysis on all model parameters, with multiway sensitivity analysis on variables to which the
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