Cost-effectiveness analysis of introduction of rapid, alternative methods to identify multidrug-resistant tuberculosis in middle-income countries.
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.
Acuna-Villaorduna
Carlos
C
Instituto de Medicina Tropical Alexander Von Humboldt, Lima, Peru.
Vassall
Anna
A
Henostroza
German
G
Seas
Carlos
C
Guerra
Humberto
H
Vasquez
Lucy
L
Morcillo
Nora
N
Saravia
Juan
J
O'Brien
Richard
R
Perkins
Mark D
MD
Cunningham
Jane
J
Llanos-Zavalaga
Luis
L
Gotuzzo
Eduardo
E
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
D000995:Antitubercular Agents; D001426:Bacterial Proteins; D011933:Reagent Kits, Diagnostic; C505805:rpoB protein, Mycobacterium tuberculosis; D012321:DNA-Directed RNA Polymerases