New test for tuberculosis could improve treatment, prevent deaths in Southern Africa
A new rapid test for tuberculosis (TB) could substantially and cost-effectively reduce TB deaths and improve treatment in southern Africa—a region where both HIV and tuberculosis are common—according to a new study by Harvard School of Public researchers.
"This test is one of the most significant developments in TB control options in many years," said lead author Nicolas Menzies, a PhD candidate in health policy at Harvard School of Public Health. "Our study is the first to look at the long-term consequences of this test when incorporated into routine health programs."
Tuberculosis is an infectious disease that kills more than 1.5 million people annually—primarily in low- and middle-income countries. An estimated 9 million people developed the disease in 2010. HIV-infected patients are particularly vulnerable to TB, which is spread through airborne droplets when people with active disease cough or sneeze.
Rapid and accurate diagnosis is key to preventing the spread of the disease. The World Health Organization (WHO) recently recommended the use of Xpert, an automated DNA test that can show a result within two hours, for people at high risk of multi-drug resistant TB and/or HIV-associated TB. Many countries are already moving to adopt the test.
Menzies, senior author Joshua Salomon, professor of global health at HSPH, and colleagues conducted a modeling study to investigate the potential health and economic consequences of implementing the Xpert test in Botswana, Lesotho, Namibia, South Africa, and Swaziland. They found that replacing the current diagnostic approach (which relies on identifying TB in patient's sputum using a microscope) with one based on the Xpert test would prevent an estimated 132,000 TB cases and 182,000 TB deaths in southern Africa over 10 years, reducing by 28% the proportion of the population with active TB.
The researchers estimated that the cost of widespread implementation of the Xpert test in southern Africa would be US$460 million over the next 10 years, with the majority of these additional costs arising from increased utilization of TB and HIV treatment services. In particular, as the new test provides information on TB drug resistance, many more patients would be referred for treatment of multi-drug resistant TB, which is expensive in this setting. The additional HIV treatment costs are a result of the success of the intervention—as individuals coinfected with TB and HIV receive better TB care, their survival improves, increasing the total number of people receiving HIV treatment.
Taking into account both the additional costs and health benefits from use of the new technology, adoption of the Xpert test in southern Africa would be a good value for the money, according to WHO standards. The researchers found that the cost per year of healthy life gained from adopting the new test ranged from US$792 in Swaziland to US$1,257 in Botswana. While these results suggest that scaling up Xpert can be a good health investment, the cost per healthy year gained is substantially higher in this study than in previous reports, and the economic results raise questions about affordability that will be critical for policy makers to consider.
Menzies also cautioned that the study's findings may not be applicable elsewhere, and that other countries may find more cost-effective interventions than Xpert to adopt first. "Given the fundamental influence of HIV on TB dynamics and intervention costs, care should be taken when interpreting the results of this analysis outside of settings with high HIV prevalence," he said.
More information: "Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTB/RIF: A Dynamic Simulation and Economic Evaluation," Menzies NA, Cohen T, Lin H-H, Murray M, Salomon JA (2012) PLoS Med 9(11): e1001347. doi:10.1371/journal.pmed.1001347
Provided by Harvard School of Public Health
- XPert MTB/RIF cost effective for TB diagnosis in low- and middle-income settings Nov 08, 2011 | not rated yet | 0
- New TB drug-resistance test shows promise but needs investment for those diagnosed to be cured Jul 26, 2011 | not rated yet | 0
- HIV/AIDS linked to drug resistant TB Nov 16, 2006 | not rated yet | 0
- South Africa to test all HIV patients for TB Oct 13, 2010 | not rated yet | 0
- Highlight: New TB diagnostic proves effective, expedient, study finds Sep 01, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the ...
Diseases, Conditions, Syndromes 10 hours ago | not rated yet | 0
There are significant cost and risk factors associated with two procedures commonly used to diagnose or treat gastrointestinal problems, according to research presented at Digestive Disease Week (DDW).
Diseases, Conditions, Syndromes 22 hours ago | not rated yet | 0
Regular consumption of coffee is associated with a reduced risk of primary sclerosing cholangitis (PSC), an autoimmune liver disease, Mayo Clinic research shows. The findings were being presented at the Digestive Disease ...
Diseases, Conditions, Syndromes 22 hours ago | not rated yet | 0 |
A new case of the deadly coronavirus has been detected in Saudi Arabia where 15 people have already died after contracting it, the health ministry announced on Saturday on its Internet website.
Diseases, Conditions, Syndromes May 18, 2013 | not rated yet | 0
(HealthDay)—Few randomized clinical trials have been done to assess clinical prediction rules for patients with lower back pain, and the trials that have been done are of low quality and do not provide ...
Diseases, Conditions, Syndromes May 17, 2013 | not rated yet | 0 |
Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma. Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin ...
10 hours ago | not rated yet | 0 |
Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, ...
11 hours ago | 4.8 / 5 (4) | 0 |
In their quest to learn more about the variability of cells between and within tissues, biomedical scientists have devised tools capable of simultaneously measuring dozens of characteristics of individual ...
11 hours ago | 5 / 5 (2) | 0 |
A new study looking at sleep-disordered breathing (SDB) and markers for Alzheimer's disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.
10 hours ago | 5 / 5 (2) | 0 |
The hunt for an HIV vaccine has gobbled up $8 billion in the past decade, and the failure of the most recent efficacy trial has delivered yet another setback to 26 years of efforts.
15 hours ago | not rated yet | 0
Patients with treatment-resistant major depression saw dramatic improvement in their illness after treatment with ketamine, an anesthetic, according to the largest ketamine clinical trial to-date led by researchers from the ...
22 hours ago | 4.8 / 5 (5) | 1 |