title: Cost-effectiveness analysis of introduction of rapid, alternative methods to identify multidrug-resistant tuberculosis in middle-income countries.
abstract: BACKGROUND
  Resistance to commonly used antituberculosis drugs is emerging worldwide. Conventional drug-susceptibility testing (DST) methods are slow and demanding. Alternative, rapid DST methods would permit the early detection of drug resistance and, in turn, arrest tuberculosis transmission.
  
  
  METHODS
  A cost-effectiveness analysis of 5 DST methods was performed in the context of a clinical trial that compared rapid with conventional DST methods. The methods under investigation were direct phage-replication assay (FASTPlaque-Response; Biotech), direct amplification and reverse hybridization of the rpoB gene (INNO-LiPA; Innogenetics), indirect colorimetric minimum inhibitory concentration assay (MTT; ICN Biomedicals), and direct proportion method on Löwenstein-Jensen medium. These were compared with the widely used indirect proportion method on Löwenstein-Jensen medium.
  
  
  RESULTS
  All alternative DST methods were found to be cost-effective, compared with other health care interventions. DST methods also generate substantial cost savings in settings of high prevalence of multidrug-resistant tuberculosis. Excluding the effects of transmission, the direct proportion method on Löwenstein-Jensen medium was the most cost-effective alternative DST method for patient groups with prevalences of multidrug-resistant tuberculosis of 2%, 5%, 20%, and 50% (cost in US$2004, $94, $36, $8, and $2 per disability-adjusted life year, respectively).
  
  
  CONCLUSIONS
  Alternative, rapid methods for DST are cost-effective and should be considered for use by national tuberculosis programs in middle-income countries.
authors.affiliation: Instituto de Medicina Tropical Alexander Von Humboldt, Lima, Peru.
authors.forename: Carlos
authors.initials: C
authors.lastname: Acuna-Villaorduna
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
authors.forename: German
authors.initials: G
authors.lastname: Henostroza
authors.forename: Carlos
authors.initials: C
authors.lastname: Seas
authors.forename: Humberto
authors.initials: H
authors.lastname: Guerra
authors.forename: Lucy
authors.initials: L
authors.lastname: Vasquez
authors.forename: Nora
authors.initials: N
authors.lastname: Morcillo
authors.forename: Juan
authors.initials: J
authors.lastname: Saravia
authors.forename: Richard
authors.initials: R
authors.lastname: O'Brien
authors.forename: Mark D
authors.initials: MD
authors.lastname: Perkins
authors.forename: Jane
authors.initials: J
authors.lastname: Cunningham
authors.forename: Luis
authors.initials: L
authors.lastname: Llanos-Zavalaga
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D003124:Colorimetry; D003362:Cost-Benefit Analysis; D012321:DNA-Directed RNA Polymerases; D024901:Drug Resistance, Multiple, Bacterial; D005784:Gene Amplification; D006801:Humans; D007182:Income / Q000145:classification; D008826:Microbial Sensitivity Tests / Q000191:economics / Q000379:methods; D009160:Mycobacteriophages / Q000502:physiology; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development; D009693:Nucleic Acid Hybridization; D010568:Peru; D019057:Quality-Adjusted Life Years; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D001426:Bacterial Proteins; D011933:Reagent Kits, Diagnostic; C505805:rpoB protein, Mycobacterium tuberculosis; D012321:DNA-Directed RNA Polymerases