|LETTER TO EDITOR
|Year : 2019 | Volume
| Issue : 3 | Page : 210-211
Cost-effectiveness analysis of classical sputum examination versus molecular diagnosis by genexpert test for tuberculosis screening among the elderly
Pathum Sookaromdee1, Viroj Wiwanitkit2
1 TWS Medical Centre, Bangkok, Thailand
2 Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India
|Date of Submission||07-Dec-2018|
|Date of Decision||18-Dec-2018|
|Date of Acceptance||26-Dec-2018|
|Date of Web Publication||10-Sep-2019|
Dr. Pathum Sookaromdee
TWS Medical Centre, Bangkok
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sookaromdee P, Wiwanitkit V. Cost-effectiveness analysis of classical sputum examination versus molecular diagnosis by genexpert test for tuberculosis screening among the elderly. Biomed Biotechnol Res J 2019;3:210-1
|How to cite this URL:|
Sookaromdee P, Wiwanitkit V. Cost-effectiveness analysis of classical sputum examination versus molecular diagnosis by genexpert test for tuberculosis screening among the elderly. Biomed Biotechnol Res J [serial online] 2019 [cited 2020 Jul 3];3:210-1. Available from: http://www.bmbtrj.org/text.asp?2019/3/3/210/266560
Pulmonary tuberculosis is still an important medical problem affecting patients worldwide. For the elderly, pulmonary tuberculosis is also an important problem. Yew et al. noted that an immunological dysfunction due to aging was an important factor increasing the risk for tuberculosis among geriatric patients. The cost for management of the mycobacterial infection becomes the big public health consideration at present. Increasing cost is observed in several countries worldwide. Effective management is the key point for public health management on tuberculosis including its economic burden. An early diagnosis is important for effective management of tuberculosis. The screening is the basic public health policies against pulmonary tuberculosis in the endemic area. The primary screening for pulmonary tuberculosis is usually a chest X-ray investigation. In the case with abnormal chest X-ray finding, additional test is required and the routine classical test is the sputum examination for finding for acid-fast bacilli. However, the negative result from sputum examination despite there is a disease is not uncommon and becomes the important concern in laboratory medicine. The active case finding becomes the important concept for effective tuberculosis control at present. An active screening focusing on the risk group is necessary for disease control. To achieve this target, the use of new effective diagnostic investigation is necessary.
There are many new diagnostic tests including the molecular diagnostic tool for the diagnosis of pulmonary tuberculosis. The important consideration on the new tests is the cost. To select a proper test, there should be an assessment of cost-effectiveness. Here, the authors perform a cost-effectiveness analysis to compare classical sputum examination versus molecular diagnosis by GeneXpert test for tuberculosis screening among the elderly. The study setting is Thailand, a tropical country where pulmonary tuberculosis is endemic. The primary data on the diagnostic test evaluation for screening for pulmonary tuberculosis in the setting in a previous study are used. Regarding the effectiveness, the diagnostic rate of each studied test is used. In addition, the cost of the test is referred to the standard cost provided by the Thai Ministry of Public Health. The cost-effectiveness analysis is done, and the result is shown in [Table 1]. According to the analysis, the cost per diagnosis of using GeneXpert is less than other alternative options. It can show that the GeneXpert test is more cost-effective for tuberculosis screening among the elderly. The result from this cost-effective analysis is concordant with the previous report from other settings such as Spain and India. It can be seen that the GeneXpert test is proven cost-effective in both developing and developed countries. Vella et al. noted that GeneXpert test was the possible most cost-effective method for tuberculosis diagnosis in the country with high incidence of multidrug-resistant tuberculosis. The present study is based on the data from Thailand, a country with high incidence of multidrug-resistant tuberculosis, and it can confirm that GeneXpert is a cost-effective option. In fact, GeneXpert should be a good alternative test for screening compared to other cost-effective approaches for tuberculosis detection such as microcolony broth culture method. The GeneXpert test is easier to perform compared to culture method.
|Table 1: Cost-effectiveness analysis of classical sputum examination versus molecular diagnosis by GeneXpert test for tuberculosis screening among the elderly|
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