title: Cost utility of lateral-flow urine lipoarabinomannan for tuberculosis diagnosis in HIV-infected African adults.
abstract: METHODS
  In-patient hospitals in South Africa and Uganda.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of a lateral-flow urine lipoarabinomannan (LAM) test when added to existing strategies for tuberculosis (TB) diagnosis in human immunodeficiency virus infected adults (CD4(+) T-cell counts < 100 cells/l) with symptoms of active TB.
  
  
  METHODS
  Decision-analytic cost-utility model, with the primary outcome being the incremental cost-effectiveness ratio, expressed in 2010 US dollars per disability-adjusted life year (DALY) averted from the perspective of a public sector TB control program.
  
  
  CONCLUSIONS
  For every 1000 patients tested, adding lateral-flow urine LAM generated 80 incremental appropriate anti-tuberculosis treatments and averted 224 DALYs. Estimated cost utility was US$353 per DALY averted (95% uncertainty range $192$1161) in South Africa and $86 per DALY averted (95% uncertainty range $49$239) in Uganda, reflecting the lower treatment costs in Uganda. Cost utility was most sensitive to assay specificity, cost of anti-tuberculosis treatment, life expectancy after TB cure and cohort TB prevalence, but did not rise above $1500 per DALY averted in South Africa under any one-way sensitivity analysis. The probability of acceptability was >99.8% at a per-DALY willingness-to-pay threshold equal to the per capita gross domestic product in South Africa ($7275) and Uganda ($509).
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: D
authors.initials: D
authors.lastname: Sun
authors.forename: S
authors.initials: S
authors.lastname: Dorman
authors.forename: M
authors.initials: M
authors.lastname: Shah
authors.forename: Y C
authors.initials: YC
authors.lastname: Manabe
authors.forename: V M
authors.initials: VM
authors.lastname: Moodley
authors.forename: M P
authors.initials: MP
authors.lastname: Nicol
authors.forename: D W
authors.initials: DW
authors.lastname: Dowdy
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000652:urine; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003906:Developing Countries / Q000191:economics*; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D008070:Lipopolysaccharides / Q000652:urine*; D018803:Models, Economic; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000652:urine; D014454:Uganda / Q000453:epidemiology; D016482:Urinalysis / Q000191:economics; D055815:Young Adult
chemical_list: D015415:Biomarkers; D008070:Lipopolysaccharides; C050016:lipoarabinomannan