ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2013
The health-system benefits and cost-effectiveness of using Mycobacterium tuberculosis direct nucleic acid amplification testing to diagnose tuberculosis disease in the United States.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 39 citations in OpenAlex.
- Nucleic Acid-based Testing for Noninfluenza Viral Pathogens in Adults with Suspected Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline.American journal of respiratory and critical care medicine · 2021Guideline
- Diagnostic accuracy of nucleic acid amplification tests (NAATs) in urine for genitourinary tuberculosis: a systematic review and meta-analysis.BMC infectious diseases · 2017Pooled it
- Racial and ethnic disparities in diagnosis and treatment outcomes among US-born people diagnosed with tuberculosis, 2003-19: an analysis of national surveillance data.The Lancet. Public health · 2024Article
- Nucleic acid amplification tests reduce delayed diagnosis and misdiagnosis of pulmonary tuberculosis.Scientific reports · 2022Article
- Epidemiology and Prevention of Tuberculosis and Chronic Hepatitis B Virus Infection in the United States.Journal of immigrant and minority health · 2021Review
- Use of Nucleic Acid Amplification Testing for Rapid Detection ofOpen forum infectious diseases · 2021Article
- Measuring health-care delays among privately insured patients with tuberculosis in the USA: an observational cohort study.The Lancet. Infectious diseases · 2021Observational
- A 28-Year-Old Man from India with SARS-Cov-2 and Pulmonary Tuberculosis Co-Infection with Central Nervous System Involvement.The American journal of case reports · 2020Article
- Impact of nucleic acid amplification test on pulmonary tuberculosis notifications and treatments in Taiwan: a 7-year single-center cohort study.BMC infectious diseases · 2019Article
- Clinical mimics: an emergency medicine focused review of pneumonia mimics.Internal and emergency medicine · 2018Review
- Performance of a Highly Sensitive Mycobacterium tuberculosis Complex Real-Time PCR Assay for Diagnosis of Pulmonary Tuberculosis in a Low-Prevalence Setting: a Prospective Intervention Study.Journal of clinical microbiology · 2018Article
- Clinical Impact and Cost-effectiveness of Xpert MTB/RIF Testing in Hospitalized Patients With Presumptive Pulmonary Tuberculosis in the United States.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2017Article
- Use of Nucleic Acid Amplification Tests in Tuberculosis Patients in California, 2010-2013.Open forum infectious diseases · 2016Article
- Impact of GeneXpert MTB/RIF assay on triage of respiratory isolation rooms for inpatients with presumed tuberculosis: a hypothetical trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2014Article
- Emerging technologies for the clinical microbiology laboratory.Clinical microbiology reviews · 2014Review
- Xpert MTB/RIF assay shortens airborne isolation for hospitalized patients with presumptive tuberculosis in the United States.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2014Observational
- Impact of GeneXpert MTB/RIF on patients and tuberculosis programs in a low-burden setting. a hypothetical trial.American journal of respiratory and critical care medicine · 2014Observational
- Article
- Availability of an assay for detecting Mycobacterium tuberculosis, including rifampin-resistant strains, and considerations for its use - United States, 2013.MMWR. Morbidity and mortality weekly report · 2013Article
- Rapid molecular testing for TB to guide respiratory isolation in the U.S.: a cost-benefit analysis.PloS one · 2013Article
Corrections and comments
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Authors and funding
13 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundThe utility of Mycobacterium tuberculosis direct nucleic acid amplification testing (MTD) for pulmonary tuberculosis disease diagnosis in the United States has not been well described.
methodsWe analyzed a retrospective cohort of reported patients with suspected active pulmonary tuberculosis in 2008-2010 from Georgia, Hawaii, Maryland, and Massachusetts to assess MTD use, effectiveness, health-system benefits, and cost-effectiveness.
resultsAmong 2140 patients in whom pulmonary tuberculosis was suspected, 799 (37%) were M. tuberculosis-culture-positive. Eighty percent (680/848) of patients having acid-fast-bacilli-smear-positive specimens had MTD performed; MTD positive-predictive value (PPV) was 98% and negative-predictive value (NPV) was 94%. Nineteen percent (240/1292) of patients having smear-negative specimens had MTD; MTD PPV was 90% and NPV was 88%. Among patients suspected of tuberculosis but not having MTD, smear PPV for lab-confirmed tuberculosis was 77% and NPV 78%. Compared with no MTD, MTD significantly decreased time to diagnosis in patients with smear-positive/MTD-positive specimens, decreased respiratory isolation for patients having smear-positive/MTD-negative/culture-negative specimens, decreased outpatient days of unnecessary tuberculosis medications, and reduced resources expended on contact investigation. While MTD generally cost more than no MTD, incremental cost savings occurred in patients with human immunodeficiency virus (HIV) or homelessness to diagnose or to exclude tuberculosis, and in patients with substance abuse having smear-negative specimens to exclude tuberculosis.
conclusionsMTD improved diagnostic accuracy and timeliness and reduced unnecessary respiratory isolation, treatment, and contact investigations. It was cost saving in patients with HIV, homelessness, or substance abuse, but not in others.
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