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Rapid Molecular Testing for TB to Guide Respiratory Isolation in the U.S.: A Cost-Benefit Analysis
- Source :
- PLoS ONE, PLoS ONE, Vol 8, Iss 11, p e79669 (2013)
- Publication Year :
- 2013
- Publisher :
- Public Library of Science, 2013.
-
Abstract
- Background: Respiratory isolation of inpatients during evaluation for TB is a slow and costly process in low-burden settings. Xpert MTB/RIF (Xpert) is a novel molecular test for tuberculosis (TB) that is faster and more sensitive but substantially more expensive than smear microscopy. No previous studies have examined the costs of molecular testing as a replacement for smear microscopy in this setting. Methods: We conducted an incremental cost–benefit analysis comparing the use of a single negative Xpert versus two negative sputum smears to release consecutive adult inpatients with presumed TB from respiratory isolation at an urban public hospital in the United States. We estimated all health-system costs and patient outcomes related to Xpert implementation, diagnostic evaluation, isolation, hospitalization, and treatment. We performed sensitivity and probabilistic uncertainty analyses to determine at what threshold the Xpert strategy would become cost-saving. Results: Among a hypothetical cohort of 234 individuals undergoing evaluation for presumed active TB annually, 6.4% had culture-positive TB. Compared to smear microscopy, Xpert reduced isolation bed utilization from an average of 2.7 to 1.4 days per patient, leading to a 48% reduction in total annual isolation bed usage from 632 to 328 bed-days. Xpert saved an average of $2,278 (95% uncertainty range $1582–4570) per admission, or $533,520 per year, compared with smear microscopy. Conclusions: Molecular testing for TB could provide substantial savings to hospitals in high-income countries by reducing respiratory isolation usage and overall length of stay.
- Subjects :
- medicine.medical_specialty
Tuberculosis
Isolation (health care)
Cost-Benefit Analysis
lcsh:Medicine
Mycobacterium tuberculosis
03 medical and health sciences
0302 clinical medicine
Active tb
Medicine
Humans
030212 general & internal medicine
lcsh:Science
Tuberculosis, Pulmonary
Phylogeny
0303 health sciences
Multidisciplinary
biology
Cost–benefit analysis
030306 microbiology
business.industry
lcsh:R
biology.organism_classification
medicine.disease
United States
3. Good health
Surgery
Respiratory isolation
Emergency medicine
Cohort
Sputum
lcsh:Q
medicine.symptom
business
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 8
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....6c0115362ffc5e401702808a9cb6abf4