title: Cost-utility analysis of LED fluorescence microscopy in the diagnosis of pulmonary tuberculosis in Indian settings.
abstract: BACKGROUND
  With support from the Stop TB Partnership's TB REACH Wave 2 Grant, diagnostic microscopy services for tuberculosis (TB) were upgraded from conventional Ziehl-Neelsen (ZN) based sputum microscopy to light emitting diode technology-based fluorescence microscopy (LED FM) in 200 high-workload microscopy centres in India as a pilot intervention.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of LED-FM over conventional ZN microscopy to inform further scale-up.
  
  
  METHODS
  A decision-tree model was constructed to assess the cost utility of LED FM over ZN microscopy. The results were summarised using incremental cost-effectiveness ratio (ICER); one-way and probabilistic sensitivity analyses were also conducted to address uncertainty within the model. Data were analysed from 200 medical colleges in 2011 and 2012, before and after the introduction of LED microscopes. A full costing analysis was carried out from the perspective of a national TB programme.
  
  
  RESULTS
  The ICER was calculated at US$14.64 per disability-adjusted life-year, with an 82% probability of being cost-effective at a willingness-to-pay threshold equivalent to Indian gross domestic product per capita.
  
  
  CONCLUSIONS
  LED FM is a cost-effective intervention for detecting TB cases in India at high-workload medical college settings.
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
authors.forename: V
authors.initials: V
authors.lastname: Kelly
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
authors.forename: K D
authors.initials: KD
authors.lastname: Sagili
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Satyanarayana
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
authors.forename: L W
authors.initials: LW
authors.lastname: Reza
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
authors.forename: S S
authors.initials: SS
authors.lastname: Chadha
authors.affiliation: Independent Public Health Consultant, Cherambadi, Tamil Nadu, India.
authors.forename: N C
authors.initials: NC
authors.lastname: Wilson
mesh_terms: D001431:Bacteriological Techniques / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D003906:Developing Countries / Q000191:economics*; D059066:Gross Domestic Product; D017048:Health Care Costs; D006801:Humans; D007194:India; D008856:Microscopy, Fluorescence / Q000191:economics*; D018803:Models, Economic; D015233:Models, Statistical; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015397:Program Evaluation; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000191:economics* / Q000382:microbiology; D035501:Uncertainty