HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Rajalahti, I. Articles by Nieminen, M.M. Search for Related Content PubMed PubMed Citation Articles by Rajalahti, I. Articles by Nieminen, M.M.

Economic evaluation of the use of PCR assay in diagnosing pulmonary TB in a low-incidence area

¹ Dept of Pulmonary Diseases, Tampere University Hospital, and ⁴ Dept of Respiratory Medicine, Medical School, University of Tampere, Tampere, ² Dept of Pulmonary Diseases, Turku University Central Hospital, Preitilä, and ³ Dept of Public Health, University of Helsinki, Helsinki, Finland

CORRESPONDENCE: I. Rajalahti, Dept of Pulmonary Diseases, Tampere University Hospital, PO Box 2000, FIN-33521, Tampere, Finland. Fax: 358 36292192. E-mail: iiris.rajalahti@kolumbus.fi

Keywords: cost-effectiveness, diagnosis, polymerase chain reaction test, pulmonary tuberculosis

Received: January 28, 2003
Accepted October 13, 2003

This study was supported by the Finnish Anti-Tuberculosis Association Foundation, the Tampere Tuberculosis Foundation, the Research Fund of Tampere University, the Medical Research Fund of Tampere University Hospital, and Roche Ltd.

To determine whether polymerase chain reaction (PCR) testing in the initial diagnosis of pulmonary tuberculosis (TB) is cost-effective in a low-prevalence population, an economic evaluation was carried out between the smear and culture (NOPCR) and smear, culture and PCR (+PCR) strategies.

A decision tree model based on retrospective laboratory data was developed to assess the strategies of testing patients with suspicion of TB. Direct healthcare costs prior to confirmation of TB or nontuberculous mycobacteria by PCR or culture were included. Effectiveness was measured by the probability of correct treatment and isolation decisions.

In the baseline situation NOPCR costs 29.50 less than the +PCR strategy per patient tested. According to sensitivity analyses, reducing PCR test price, shortening test performance time or increasing the proportion of smear-positive patients in the tested population would contribute to cost savings with the +PCR strategy.

Routine polymerase chain reaction testing of all specimens from suspected tuberculosis patients in a low-prevalence population was not cost-saving. When the polymerase chain reaction assay was applied only to smear-positive sputum specimens, the smear and culture strategy was clearly dominated by it, i.e. the polymerase chain reaction smear-positive sputum strategy was less costly and more effective in producing correct treatment decisions and isolations.

This article has been cited by other articles:

				M. Campos, A. Quartin, E. Mendes, A. Abreu, S. Gurevich, L. Echarte, T. Ferreira, T. Cleary, E. Hollender, and D. Ashkin Feasibility of Shortening Respiratory Isolation with a Single Sputum Nucleic Acid Amplification Test Am. J. Respir. Crit. Care Med., August 1, 2008; 178(3): 300 - 305. [Abstract] [Full Text] [PDF]