Álvarez PMÁ, Morales PXA, Rodríguez-Ramírez A, Hernández-SJM

Language: Spanish
References: 20
Page: 129-133
PDF size: 176.75 Kb.

ABSTRACT

Introduction. In Colombia there are different tests for tuberculosis diagnostic, smear microscopy is the most commonly used. With the availability of molecular tests, it is important to identify which are the most cost-effective options for tuberculosis diagnosis.
Objective. To evaluate the costs and cost-effectiveness of three pulmonary tuberculosis diagnostic tests, in two Colombia cities in 2015.
Methods. Descriptive and retrospective study. Results and commercial value of three diagnostic tests, used in pulmonary tuberculosis diagnosis in symptomatic patients from Medellin and Pereira cities during 2015 were collected. A cost-effectiveness analysis was conducted.
Results. In 1 424 cases of pulmonary tuberculosis in Medellin, each positive case detected by sputum smear had a cost of 930 519 Colombian pesos (CP) (300.17 dollars); by culture 1 640 770 CP (529.28 dollars) and 4 900 616 CP (1 580.84 dollars) by Xpert mtb/rif^® (Xpert). Comparing with sputum smear there was an additional cost of 4 302 344 cp (1 387.85 dollars) and 26 207 467 CP (8 454.02 dollars) in every case detected by culture and Xpert, respectively. In 392 pulmonary tuberculosis cases in Pereira, each positive case had a cost of 471 615 cp (152.12 dollars), 997 315 cp (321.71 dollars) and 6 099 404 cp (1 967.55 dollars) by sputum smear, culture and Xpert, respectively. Culture and Xpert had a higher cost per every case of 2 968 690 CP (957.64 dollars) and 36 248 274 CP (11 692.99 dollars), respectively when comparing with smear microscopy.
Conclusion. Culture and the Xpert mtb are more expensive but more effective compared with smear microscopy. Culture is less expensive but less effective than Xpert mtb. According to the results, in Colombia the Xpert until now is not recommended as a routine diagnostic method; however, it should be taken into account for some specific cases considering a better diagnosis opportunity.

REFERENCES

1. Instituto Nacional de Salud, Protocolo de Vigilancia en Salud Pública: Tuberculosis, 2017.

2. Instituto Nacional de Salud, Boletín Epidemiológico Semanal, Semana epidemiológica núm. 52 de 2015, 2015.

3. Ministerio de la Protección Social, Guías de promoción de la salud y prevención de las enfermedades en la salud pública, t. ii, Editorial Scripto, Bogotá, 2007.

4. Instituto Nacional de Salud, Guía para la vigilancia por laboratorio de tuberculosis, 2017.

5. Organización Mundial de la Salud (oms), Implementing tuberculosis diagnostics. Policy framework, oms, 2015.

6. Guerrero, R., Guevara, C. y Parody, E., “Guía metodológica para la realización de evaluaciones económicas en el marco de Guías de Práctica Clínica”, 2014.

7. Álvarez, G., García, M. y Londoño, M., “Crisis de la salud en Colombia: limitantes del acceso al derecho fundamental a la salud de los adultos mayores”, ces Derecho, 2016, 7 (2).

8. Prieto, L., Sacristán, J., Antoñanzas, F., Rubio, C., Pinto, J. y Rovira, J., “Análisis coste-efectividad en la evaluación económica de intervenciones sanitarias”, Med Clin, 2004, 122 (13): 505-510.

9. Steingart, K.R., Schiller, I., Horne, D.J., Pai, M., Boehme, C.C. y Dendukuri, N., “Xpert® mtb/rif assay for pulmonary tuberculosis and rifampicin resistance in adults”, Cochrane Database Syst Rev, 2014, 1: CD009593.

10. Organización Panamericana de la Salud (ops), Manual para el diagnóstico bacteriológico de la tuberculosis. Parte 1. Baciloscopia, ops, 2008.

11. Nicol, M., Workman, L., Isaacs, W., Munro, J., Black, F., Eley, B. et al., “Accuracy of the Xpert mtb/rif test for the diagnosis of pulmonary tuberculosis in children admitted to hospital in Cape Town, South Africa: a descriptive study”, Lancet Infect Dis, 2011, 11 (11): 819-824.

12. Boehme, C., Nicol, M., Nabeta, P., Michael, J., Gotuzzo, E., Tahirli, R. et al., “Feasibility, diagnostic accuracy, and effectiveness of decentralised use of the Xpert mtb/rif test for diagnosis of tuberculosis and multidrug resistance: a multicentre implementation study”, Lancet, 2011, 377 (9776): 1495-1505.

13. Organización Mundial de la Salud (oms), tbxpert project, 2016. Disponible en: http://www.who.int/tb/publications/ TBXpert_briefing_note.pdf.

14. Gobierno de Colombia, Decreto 2423 de diciembre de 1996, actualizado en 2015, Manual Tarifario soat.

15. Organización Mundial de la Salud (oms), “Tuberculosis diagnostics: automated real-time dna amplification test for rapid and simultaneous detection of tb and rifampicin resistance”, 2016. Disponible en: http://www.who.int/tb/ publications/factsheet_xpert.pdf?ua=1.

16. Herráez, O., Asencio-Egea, M.A., Huertas-Vaquero, M., Carranza-González, R., Castellanos-Monedero, J., Franco- Huerta, M. et al., “Estudio de coste-efectividad del diagnóstico microbiológico de tuberculosis mediante geneXpert mtb/ rif®, Enferm Infecc Microbiol Clin, 2017, 35 (7): 403-410.

17. You, J.H.S., Lui, G., Kam, K.M. y Lee, N.L.S., “Cost-effectiveness analysis of the Xpert mtb/rif assay for rapid diagnosis of suspected tuberculosis in an intermediate burden area”, J Infect, 2015, 70: 409-414.

18. Naidoo, P., Dunbar, R., Du Toit, E., Van Niekerk, M., Squire, S.B., Beyers, N. et al., “Comparing laboratory costs of smear/ culture and Xpert® mtb/rif based tuberculosis diagnosis algorithms”, Int J Tuberc Lung Dis, 2016, 20 (10): 1377-1385.

19. Organización Panamericana de la Salud (ops), “Preguntas frecuentes sobre el método Xpert mtb/rif”, 2011. Disponible en: http://www1.paho.org/hq/dmdocuments/2011/ Preguntas_frecuentes_Xper_MTB-RIF_final.pdf.

20. Organización Mundial de la Salud (oms), Implementing tuberculosis diagnostics, oms, 2015.