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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 210-211

Cost-effectiveness analysis of classical sputum examination versus molecular diagnosis by genexpert test for tuberculosis screening among the elderly


1 TWS Medical Centre, Bangkok, Thailand
2 Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India

Date of Submission07-Dec-2018
Date of Decision18-Dec-2018
Date of Acceptance26-Dec-2018
Date of Web Publication10-Sep-2019

Correspondence Address:
Dr. Pathum Sookaromdee
TWS Medical Centre, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_137_18

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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 2019 Nov 20];3:210-1. Available from: http://www.bmbtrj.org/text.asp?2019/3/3/210/266560



Dear Editor,

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.[1] The cost for management of the mycobacterial infection becomes the big public health consideration at present.[2] Increasing cost is observed in several countries worldwide.[2] 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.[3] The active case finding becomes the important concept for effective tuberculosis control at present.[4] An active screening focusing on the risk group is necessary for disease control.[4] 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.[5] 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[6] and India.[7] 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.[8] 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.[9] 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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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yew WW, Yoshiyama T, Leung CC, Chan DP. Epidemiological, clinical and mechanistic perspectives of tuberculosis in older people. Respirology 2018;23:567-75.  Back to cited text no. 1
    
2.
Mirsaeidi M, Allen MB, Ebrahimi G, Schraufnagel D. Hospital costs in the US for pulmonary mycobacterial diseases. Int J Mycobacteriol 2015;4:217-21.  Back to cited text no. 2
  [Full text]  
3.
Dutt AK, Stead WW. Smear-negative pulmonary tuberculosis. Semin Respir Infect 1994;9:113-9.  Back to cited text no. 3
    
4.
Ho J, Fox GJ, Marais BJ. Passive case finding for tuberculosis is not enough. Int J Mycobacteriol 2016;5:374-8.  Back to cited text no. 4
  [Full text]  
5.
Kavinum S, Iemrod N. Screening for pulmonary tuberculosis among the elderly and alcholics. J Health Sci 2017;26:561-70.  Back to cited text no. 5
    
6.
HerráezÓ, Asencio-Egea MÁ, Huertas-Vaquero M, Carranza-González R, Castellanos-Monedero J, Franco-Huerta M, et al. Cost-effectiveness study of the microbiological diagnosis of tuberculosis using geneXpert MTB/RIF®. Enferm Infecc Microbiol Clin 2017;35:403-10.  Back to cited text no. 6
    
7.
Sagili KD, Muniyandi M, Nilgiriwala KS, Shringarpure KS, Satyanarayana S, Kirubakaran R, et al. Cost-effectiveness of geneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review. PLoS One 2018;13:e0205233.  Back to cited text no. 7
    
8.
Vella V, Broda A, Drobniewski F. Should all suspected tuberculosis cases in high income countries be tested with geneXpert? Tuberculosis (Edinb) 2018;110:112-20.  Back to cited text no. 8
    
9.
Irfan S, Jabeen K, Irfan M, Rao NA, Azizullah Z, Hasan R. Safe and cost-effective treatment response monitoring of MDR pulmonary tuberculosis by using micro colony broth culture method. Int J Mycobacteriol 2015;4:159-60.  Back to cited text no. 9
  [Full text]  



 
 
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