Evidence map›Paper›PMID 29499645›Full record

ArticleBMC infectious diseases2018

Cost analysis of rapid diagnostics for drug-resistant tuberculosis.

Erik J Groessl, Theodore G Ganiats, Naomi Hillery, Andre Trollip, Roberta L Jackson, Donald G Catanzaro, Timothy C Rodwell, Richard S Garfein, Camilla Rodrigues, Valeriu Crudu and 2 more

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC infectious diseases, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02170441 (Global Consortium for Drug-resistant Tuberculosis Diagnostics), which is not on this map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

NCT02170441 completednot on this map

Global Consortium for Drug-resistant Tuberculosis Diagnostics

TypeobservationalSponsorUniversity of California, San DiegoRan2012 to 2014Enrolled1,128ConditionsTuberculosis, Tuberculosis, Multidrug-Resistant
3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Article
  6. Article
  7. Article
  8. Laboratory costs of diagnosing TB in a high multidrug-resistant TB setting.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2021
    Article
  9. Article
  10. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 5 institutions in 4 countries.

Erik J GroesslDepartment of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, #0994, San Diego, CA, USA. egroessl@ucsd.edu.ORCID 0000-0001-6239-1965
Theodore G GaniatsDepartment of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, #0994, San Diego, CA, USA.
Naomi HilleryDepartment of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, #0994, San Diego, CA, USA.
Andre TrollipDepartment of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.
Roberta L JacksonDepartment of Medicine, University of California, San Diego, CA, USA.
Donald G CatanzaroUniversity of Arkansas, Little Rock, USA.
Timothy C RodwellDepartment of Medicine, University of California, San Diego, CA, USA.
Richard S GarfeinDepartment of Medicine, University of California, San Diego, CA, USA.
Camilla RodriguesHinduja National Hospital, Mumbai, India.
Valeriu CruduMicrobiology and Morphology Laboratory, Institute of Phthisiopneumology, Chisinau, Moldova.
Thomas C VictorDepartment of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.
Antonino CatanzaroDepartment of Medicine, University of California, San Diego, CA, USA.
University of California San Diego · USStellenbosch University · ZAP. D. Hinduja Hospital and Medical Research Centre · INPhthisiopneumology Institute "Chiril Draganiuc" · MDUniversity of Arkansas at Little Rock · US

Funding

VirologyP30AI036214 · NIAID · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Maile Ann Young Karris · 1994 to 2026
$78.4M
Rapid Tests for Drug Resistance to Detect Extensively Drug-Resistant TuberculosisU01AI082229 · NIAID · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI CATANZARO, ANTONINO · 2009 to 2013
$10.9M
NIAID NIH HHS P30 AI036214NIAID NIH HHS U01 AI082229
6 · The paper itself

Abstract

backgroundGrowth-based drug susceptibility testing (DST) is the reference standard for diagnosing drug-resistant tuberculosis (TB), but standard time to result (TTR) is typically ≥ 3 weeks. Rapid tests can reduce that TTR to days or hours, but accuracy may be lowered. In addition to the TTR and test accuracy, the cost of a diagnostic test may affect whether it is adopted in clinical settings. We examine the cost-effectiveness of rapid diagnostics for extremely drug-resistant TB (XDR-TB) in three different high-prevalence settings.

methods1128 patients with confirmed TB were enrolled at clinics in Mumbai, India; Chisinau, Moldova; and Port Elizabeth, South Africa. Patient sputum samples underwent DST for first and second line TB drugs using 2 growth-based (MGIT, MODS) and 2 molecular (Pyrosequencing [PSQ], line-probe assays [LPA]) assays. TTR was the primary measure of effectiveness. Sensitivity and specificity were also evaluated. The cost to perform each test at each site was recorded and included test-specific materials, personnel, and equipment costs. Incremental cost-effectiveness ratios were calculated in terms of $/day saved. Sensitivity analyses examine the impact of batch size, equipment, and personnel costs.

resultsOur prior results indicated that the LPA and PSQ returned results in a little over 1 day. Mean cost per sample without equipment or overhead was $23, $28, $33, and $41 for the MODS, MGIT, PSQ, and LPA, respectively. For diagnosing XDR-TB, MODS was the most accurate, followed by PSQ, and LPA. MODS was quicker and less costly than MGIT. PSQ and LPA were considerably faster but cost more than MODS. Batch size and personnel costs were the main drivers of cost variation.

conclusionsMultiple factors must be weighed when selecting a test for diagnosis of XDR-TB. Rapid tests can greatly improve the time required to diagnose drug-resistant TB, potentially improving treatment success, and preventing the spread of XDR-TB. Faster time to result must be weighed against the potential for reduced accuracy, and increased costs.

trial registrationClinicalTrials.gov Identifier: NCT02170441 .

Indexed as

Health Care CostsAntitubercular AgentsDrug Resistance, Multiple, BacterialExtensively Drug-Resistant TuberculosisHumansIndiaMicrobial Sensitivity TestsMoldovaMycobacterium tuberculosisSensitivity and SpecificitySouth AfricaAntitubercular AgentsCost-effectivenessDiagnosisDrug-resistant tuberculosisTime to result

Identifiers

PMID29499645
PMCPMC5833048
OpenAlexW2793445289

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.