title: Cost-effectiveness of point-of-care digital chest-x-ray in HIV patients with pulmonary mycobacterial infections in Nigeria.
abstract: BACKGROUND
  Chest-x-ray is routinely used in the diagnosis of smear negative tuberculosis (TB). This study assesses the incremental cost per true positive test of a point-of-care digital chest-x-ray, in the diagnosis of pulmonary mycobacterial infections among HIV patients with presumed tuberculosis undetected by smear microscopy.
  
  
  METHODS
  Consecutive patients with clinical suspicion of pulmonary tuberculosis were serially tested for Human immunodeficiency virus (HIV), their sputum examined for Acid Fast Bacilli then cultured in broth and solid media. Cultures characterized as tuberculous (M.tb) and non-tuberculous (NTM) mycobacteria by Hain assays were used as gold standards. A chest-x-ray was classified as: (1) consistent for TB, (2) not consistent for TB and (3) no pathology.
  
  
  RESULTS
  Of the 1391 suspected cases enrolled, complete data were available for 952 (68%): 753/952 (79%) had negative smear tests while 150/753 (20%) had cultures positive for TB. Of those, 82/150 (55%) had chest-x-ray signs consistent with TB and 29/82 (35%) were positive for HIV. Within the co-infected, 9/29 (31%) had NTM infections. Among all suspects, the cost per positive case detected using smear microscopy test was $52.84; the overall incremental cost per positive case using chest-x-ray in smear negatives was $23.42, and in smear negative, HIV positive patients the cost was $15.77.
  
  
  CONCLUSIONS
  Point-of-care chest-x-ray is a cost-effective diagnostic tool for smear negative HIV positive patients with pulmonary mycobacterial infection.
authors.affiliation: Health and Human Services, Federal Capital Territory, Abuja, Nigeria. algambo@yahoo.com.
authors.forename: Gambo
authors.initials: G
authors.lastname: Aliyu
authors.forename: Samer S
authors.initials: SS
authors.lastname: El-Kamary
authors.forename: Alash'le
authors.initials: A
authors.lastname: Abimiku
authors.forename: Laura
authors.initials: L
authors.lastname: Hungerford
authors.forename: Joshua
authors.initials: J
authors.lastname: Obasanya
authors.forename: William
authors.initials: W
authors.lastname: Blattner
mesh_terms: D000328:Adult; D060085:Coinfection / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous; D009549:Nigeria; D019095:Point-of-Care Systems / Q000191:economics*; D013902:Radiography, Thoracic / Q000191:economics*; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging*