Cost utility of lateral-flow urine lipoarabinomannan for tuberculosis diagnosis in HIV-infected African adults
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.
DESIGN: 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.
RESULTS AND CONCLUSION: 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).
Keywords: HIV; South Africa; Uganda; diagnostic tests and procedures; economic; models; tuberculosis
Document Type: Research Article
Affiliations: 1: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 2: Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA; and Tuberculosis Clinical Diagnostics Research Consortium, Baltimore, Maryland, USA 3: Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA; and Infectious Disease Institute, Kampala, Uganda 4: Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa 5: Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa 6: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA; and Tuberculosis Clinical Diagnostics Research Consortium, Baltimore, Maryland, USA
Publication date: 01 April 2013
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