title: Is introducing rapid culture into the diagnostic algorithm of smear-negative tuberculosis cost-effective?
abstract: METHODS
  In 2007, the World Health Organization recommended introducing rapid Mycobacterium tuberculosis culture into the diagnostic algorithm of smear-negative pulmonary tuberculosis (TB).
  
  
  OBJECTIVE
  To assess the cost-effectiveness of introducing a rapid non-commercial culture method (thin-layer agar), together with Löwenstein-Jensen culture to diagnose smear-negative TB at a district hospital in Kenya.
  
  
  METHODS
  Outcomes (number of true TB cases treated) were obtained from a prospective study evaluating the effectiveness of a clinical and radiological algorithm (conventional) against the alternative algorithm (conventional plus M. tuberculosis culture) in 380 smear-negative TB suspects. The costs of implementing each algorithm were calculated using a 'micro-costing' or 'ingredient-based' method. We then compared the cost and effectiveness of conventional vs. culture-based algorithms and estimated the incremental cost-effectiveness ratio.
  
  
  RESULTS
  The costs of conventional and culture-based algorithms per smear-negative TB suspect were respectively €39.5 and €144. The costs per confirmed and treated TB case were respectively €452 and €913. The culture-based algorithm led to diagnosis and treatment of 27 more cases for an additional cost of €1477 per case.
  
  
  CONCLUSIONS
  Despite the increase in patients started on treatment thanks to culture, the relatively high cost of a culture-based algorithm will make it difficult for resource-limited countries to afford.
authors.affiliation: Centre d'Etudes et de Recherches sur le Développement International, Centre National de la Recherche Scientifique, Université d'Auvergne, Clermont-Ferrand, France.
authors.forename: N
authors.initials: N
authors.lastname: Yakhelef
authors.affiliation: Centre d'Etudes et de Recherches sur le Développement International, Centre National de la Recherche Scientifique, Université d'Auvergne, Clermont-Ferrand, France.
authors.forename: M
authors.initials: M
authors.lastname: Audibert
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Varaine
authors.affiliation: Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Chakaya
authors.affiliation: National Leprosy and TB Control Programme, Nairobi, Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Sitienei
authors.affiliation: Epicentre, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Huerga
authors.affiliation: Epicentre, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bonnet
mesh_terms: D000328:Adult; D000465:Algorithms; D000995:Antitubercular Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques / Q000191:economics*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006767:Hospitals, District / Q000191:economics; D006801:Humans; D007630:Kenya; D008297:Male; D018803:Models, Economic; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013183:Sputum / Q000382:microbiology*; D013673:Technology Assessment, Biomedical / Q000191:economics; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents