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Cheng J, Zhang Y, Zhong A, Tian M, Zou G, Chen X, Yu H, Song F, Zhou S. Quality of Health Economic Evaluations in Mainland China: A Comparison of Peer-Reviewed Articles in Chinese and in English. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:35-54. [PMID: 34322862 DOI: 10.1007/s40258-021-00674-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Our objective was to assess the incidence and quality of reporting of published health economic evaluations in mainland China and compare the quality of peer-reviewed articles in Chinese and English. METHODS A comprehensive search was conducted for economic evaluations pertaining to China published from 2006 to 2015 using the PubMed, CBM, CMCC, CNKI, VIP, and Wanfang databases. All studies in English that met the inclusion criteria were included. For studies in Chinese, 200 sampled studies were included according to the random seeds method, and the same number of the most-cited studies in Chinese as those in English were included according to the number of citations and journal grades. Researchers independently assessed the quality of the studies using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS After literature search and screening, a total of 310 studies were identified. The majority of these studies were cost-effectiveness studies (82.26%). Scores among different CHEERS items varied greatly. There was a gap between the average quality scores of the studies published in Chinese and those published in English (49.78 ± 9.31 vs. 82.48 ± 17.69) and between the average quality scores of the included most-cited studies in Chinese and English, which was slightly smaller (54.08 ± 10.27 vs. 82.48 ± 17.69). The methods, results, and discussion sections of studies published in Chinese were of low quality. CONCLUSION The quality of reporting of health economic evaluations in mainland China has developed slowly. Most of the included studies were incomplete in the presentation of content, making the results less reliable. It is important to standardize and improve the quality of Chinese health economic research.
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Affiliation(s)
- Jiehua Cheng
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Yu Zhang
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Ailin Zhong
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Miao Tian
- Dongfeng Stomatological Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Guanyang Zou
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Xiaping Chen
- Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Hongxing Yu
- Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Fujian Song
- Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK
| | - Shangcheng Zhou
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China.
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Shi J, Tao B, Li Z, Song H, Wu J, Qiu B, Wang J. Diagnostic Performance of GeneChip for the Rapid Detection of Drug-Resistant Tuberculosis in Different Subgroups of Patients. Infect Drug Resist 2021; 14:597-608. [PMID: 33633456 PMCID: PMC7900445 DOI: 10.2147/idr.s297725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Drug-resistant tuberculosis (DR-TB) is a growing problem worldwide. The rapid drug susceptibility test (DST) of DR-TB enables the timely administration of a chemotherapy regimen that effectively treats DR-TB. GeneChip has been reported as a novel molecular diagnostic tool for rapid diagnosis but has limited data on the performance of subgroup patients with DR-TB. This study aims to assess the diagnostic value of GeneChip in patients with different sexes, ages, treatment histories, treatment outcomes, and places of residence. Methods We recruited newly registered sputum smear-positive pulmonary TB patients from January 2011 to September 2020 in Lianyungang City, Jiangsu Province, China. We applied both GeneChip and DST to measure drug resistance to rifampin (RIF) and isoniazid (INH). The kappa value, sensitivity, specificity, and agreement rate (AR) were calculated. We also applied a Classification and Regression Tree to explore factors related to the performance of GeneChip. Results We observed that sex, age, treatment history, treatment outcomes, and drug resistance type were significantly associated with the performance of GeneChip. For RIF resistance, there was significant accordance in young patients (kappa: 0.79) and cases with the treatment failure outcome (kappa: 0.92). For multidrug resistance (MDR), there was significant accordance in young cases (kappa: 0.77). Compared with previously treated patients, the newly treated patients had a significantly higher AR in detecting RIF resistance (0.97 vs 0.92), INH resistance (0.95 vs 0.89), and MDR (0.98 vs 0.92). The overall sensitivity, specificity, AR and kappa value for the diagnosis of MDR-TB were 0.70 (95% CI: 0.63–0.70), 0.99 (95% CI: 0.98–0.99), 0.98 (95% CI: 0.97–0.98), and 0.72 (95% CI: 0.67–0.78), respectively. Conclusion We observed a high concordance between GeneChip and DST among TB patients with different characteristics, indicating that GeneChip can be a potential alternative tool for rapid MDR-TB detection.
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Affiliation(s)
- Jinyan Shi
- Department of Clinical Laboratory, The Fourth People's Hospital of Lianyungang, Lianyungang, Jiangsu, People's Republic of China
| | - Bilin Tao
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Zhongqi Li
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Huan Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Jizhou Wu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Beibei Qiu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Jianming Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
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Lyu C, Shi H, Cui Y, Li M, Yan Z, Yan L, Jiang Y. CRISPR-based biosensing is prospective for rapid and sensitive diagnosis of pediatric tuberculosis. Int J Infect Dis 2020; 101:183-187. [PMID: 32987180 DOI: 10.1016/j.ijid.2020.09.1428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 12/27/2022] Open
Abstract
Pediatric tuberculosis (TB) is an important part of global TB prevention and control. Diagnosis of childhood TB still remains challenging when using conventional tests, due to the non-specific clinical manifestations and paucibacillary nature of the specimens. Thus, a sensitive, rapid and low-cost diagnostic test is of great demand. Benefiting from specific and rapid Cas-protein-based catalytic activities, CRISPR-based biosensing platforms (CRISPR platforms) are showing superiority in detecting pathogen nucleic acid traces in clinical samples. Based on their excellent sensitivity, and time and cost saved in existing research, this study aimed to highlight the potential of CRISPR platforms as a tool for diagnosing pediatric TB, and advocate for studies to evaluate its performance in specimens collected from children, especially noninvasive specimens. These platforms are also promising in identifying drug resistance and genotyping. All of the above will help early diagnosis of pediatric TB, thus guide reasonable treatment, and be significant in achieving the World Health Organization End-TB strategy.
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Affiliation(s)
- Chunyang Lyu
- Department of Laboratory Medicine, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Hua Shi
- Department of Laboratory Medicine, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yali Cui
- Department of Laboratory Medicine, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Mingyuan Li
- Department of Laboratory Medicine, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ziyi Yan
- Department of Laboratory Medicine, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Lingyi Yan
- Department of Laboratory Medicine, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yongmei Jiang
- Department of Laboratory Medicine, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
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Cunnama L, Gomez GB, Siapka M, Herzel B, Hill J, Kairu A, Levin C, Okello D, DeCormier Plosky W, Garcia Baena I, Sweeney S, Vassall A, Sinanovic E. A Systematic Review of Methodological Variation in Healthcare Provider Perspective Tuberculosis Costing Papers Conducted in Low- and Middle-Income Settings, Using An Intervention-Standardised Unit Cost Typology. PHARMACOECONOMICS 2020; 38:819-837. [PMID: 32363543 PMCID: PMC7437656 DOI: 10.1007/s40273-020-00910-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND There is a need for easily accessible tuberculosis unit cost data, as well as an understanding of the variability of methods used and reporting standards of that data. OBJECTIVE The aim of this systematic review was to descriptively review papers reporting tuberculosis unit costs from a healthcare provider perspective looking at methodological variation; to assess quality using a study quality rating system and machine learning to investigate the indicators of reporting quality; and to identify the data gaps to inform standardised tuberculosis unit cost collection and consistent principles for reporting going forward. METHODS We searched grey and published literature in five sources and eight databases, respectively, using search terms linked to cost, tuberculosis and tuberculosis health services including tuberculosis treatment and prevention. For inclusion, the papers needed to contain empirical unit cost estimates for tuberculosis interventions from low- and middle-income countries, with reference years between 1990 and 2018. A total of 21,691 papers were found and screened in a phased manner. Data were extracted from the eligible papers into a detailed Microsoft Excel tool, extensively cleaned and analysed with R software (R Project, Vienna, Austria) using the user interface of RStudio. A study quality rating was applied to the reviewed papers based on the inclusion or omission of a selection of variables and their relative importance. Following this, machine learning using a recursive partitioning method was utilised to construct a classification tree to assess the reporting quality. RESULTS This systematic review included 103 provider perspective papers with 627 unit costs (costs not presented here) for tuberculosis interventions among a total of 140 variables. The interventions covered were active, passive and intensified case finding; tuberculosis treatment; above-service costs; and tuberculosis prevention. Passive case finding is the detection of tuberculosis cases where individuals self-identify at health facilities; active case finding is detection of cases of those not in health facilities, such as through outreach; and intensified case finding is detection of cases in high-risk populations. There was heterogeneity in some of the reported methods used such cost allocation, amortisation and the use of top-down, bottom-up or mixed approaches to the costing. Uncertainty checking through sensitivity analysis was only reported on by half of the papers (54%), while purposive and convenience sampling was reported by 72% of papers. Machine learning indicated that reporting on 'Intervention' (in particular), 'Urbanicity' and 'Site Sampling', were the most likely indicators of quality of reporting. The largest data gap identified was for tuberculosis vaccination cost data, the Bacillus Calmette-Guérin (BCG) vaccine in particular. There is a gap in available unit costs for 12 of 30 high tuberculosis burden countries, as well as for the interventions of above-service costs, tuberculosis prevention, and active and intensified case finding. CONCLUSION Variability in the methods and reporting used makes comparison difficult and makes it hard for decision makers to know which unit costs they can trust. The study quality rating system used in this review as well as the classification tree enable focus on specific reporting aspects that should improve variability and increase confidence in unit costs. Researchers should endeavour to be explicit and transparent in how they cost interventions following the principles as laid out in the Global Health Cost Consortium's Reference Case for Estimating the Costs of Global Health Services and Interventions, which in turn will lead to repeatability, comparability and enhanced learning from others.
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Affiliation(s)
- Lucy Cunnama
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, South Africa.
| | - Gabriela B Gomez
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mariana Siapka
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Herzel
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Jeremy Hill
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Angela Kairu
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, South Africa
| | - Carol Levin
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Dickson Okello
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, South Africa
| | | | - Inés Garcia Baena
- TB Monitoring and Evaluation (TME), Global TB Programme, The World Health Organization, Geneva, Switzerland
| | - Sedona Sweeney
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Edina Sinanovic
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, South Africa
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Bogdanova EN, Mariandyshev AO, Balantcev GA, Eliseev PI, Nikishova EI, Gaida AI, Enarson D, Detjen A, Dacombe R, Phillips PPJ, Squire SB, Gospodarevskaya E. Cost minimization analysis of line probe assay for detection of multidrug-resistant tuberculosis in Arkhangelsk region of Russian Federation. PLoS One 2019; 14:e0211203. [PMID: 30695043 PMCID: PMC6350971 DOI: 10.1371/journal.pone.0211203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/09/2019] [Indexed: 12/02/2022] Open
Abstract
Background The development of new diagnostic tools allows for faster detection of both tuberculosis (TB) and multidrug-resistant (MDR) TB and should lead to reduced transmission by earlier initiation of anti TB therapy. The research conducted in the Arkhangelsk region of the Russian Federation in 2012–14 included economic evaluation of Line Probe Assay (LPA) implementation in MDR-TB diagnostics compared to existing culture-based diagnostics of Löwenstein Jensen (LJ) and BacTAlert. Clinical superiority of LPA was demonstrated and results were reported elsewhere. Study aim The PROVE-IT Russia study aimed to report the outcomes of the cost minimization analysis. Methods Costs of LPA-based diagnostic algorithm (smear positive (SSm+) and for smear negative (SSm-) culture confirmed TB patients by Bactec MGIT or LJ were compared with conventional culture-based algorithm (LJ–for SSm- and SSm+ patients and BacTAlert–for SSm+ patients). Cost minimization analysis was conducted from the healthcare system, patient and societal perspectives and included the direct and indirect costs to the healthcare system (microscopy and drug susceptibility test (DST), hospitalization, medications obtained from electronic medical records) and non-hospital direct costs (patient’s travel cost, additional expenses associated with hospitalization, supplementary medicine and food) collected at the baseline and two subsequent interviews using the WHO-approved questionnaire. Results Over the period of treatment the LPA-based diagnostic corresponded to lesser direct and indirect costs comparing to the alternative algorithms. For SSm+ LPA-based diagnostics resulted in the costs 4.5 times less (808.21 US$) than LJ (3593.81 US$) and 2.5 times less than BacTAlert liquid culture (2009.61 US$). For SSm- LPA in combination with Bactec MGIT (1480.75 US$) vs LJ (1785.83 US$) showed the highest cost minimization compared to LJ (2566.09 US$). One-way sensitivity analyses of the key parameters and threshold analyses were conducted and demonstrated that the results were robust to variations in the cost of hospitalization, medications and length of stay. Conclusion From the perspective of Russian Federation healthcare system, TB diagnostic algorithms incorporating LPA method proved to be both more clinically effective and less expensive due to reduction in the number of hospital days to the correct MDR-TB diagnosis and treatment initiation. LPA diagnostics comparing conventional culture diagnostic algorithm MDR-TB was a cost minimizing strategy for both patients and healthcare system.
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Affiliation(s)
- E. N. Bogdanova
- Northern Arctic Federal University, Arkhangelsk, Russian Federation
- * E-mail:
| | | | - G. A. Balantcev
- Northern Arctic Federal University, Arkhangelsk, Russian Federation
| | - P. I. Eliseev
- Northern State Medical University, Arkhangelsk, Russian Federation
| | - E. I. Nikishova
- Arkhangelsk Clinical Antituberculosis Dispensary, Arkhangelsk, Russian Federation
| | - A. I. Gaida
- Arkhangelsk Clinical Antituberculosis Dispensary, Arkhangelsk, Russian Federation
| | - D. Enarson
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A. Detjen
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R. Dacombe
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - S. B. Squire
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - E. Gospodarevskaya
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Deakin University, Melbourne, Australia
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Pallas SW, Courey M, Hy C, Killam WP, Warren D, Moore B. Cost Analysis of Tuberculosis Diagnosis in Cambodia with and without Xpert ® MTB/RIF for People Living with HIV/AIDS and People with Presumptive Multidrug-resistant Tuberculosis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:537-548. [PMID: 29862440 PMCID: PMC6050005 DOI: 10.1007/s40258-018-0397-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND The Xpert® MTB/RIF (Xpert) test has been shown to be effective and cost-effective for diagnosing tuberculosis (TB) under conditions with high HIV prevalence and HIV-TB co-infection but less is known about Xpert's cost in low HIV prevalence settings. Cambodia, a country with low HIV prevalence (0.7%), high TB burden, and low multidrug-resistant (MDR) TB burden (1.4% of new TB cases, 11% of retreatment cases) introduced Xpert into its TB diagnostic algorithms for people living with HIV (PLHIV) and people with presumptive MDR TB in 2012. The study objective was to estimate these algorithms' costs pre- and post-Xpert introduction in four provinces of Cambodia. METHODS Using a retrospective, ingredients-based microcosting approach, primary cost data on personnel, equipment, maintenance, supplies, and specimen transport were collected at four sites through observation, records review, and key informant consultations. RESULTS Across the sample facilities, the cost per Xpert test was US$33.88-US$37.11, clinical exam cost US$1.22-US$1.84, chest X-ray cost US$2.02-US$2.14, fluorescent microscopy (FM) smear cost US$1.56-US$1.93, Ziehl-Neelsen (ZN) smear cost US$1.26, liquid culture test cost US$11.63-US$22.83, follow-on work-up for positive culture results and Mycobacterium tuberculosis complex (MTB) identification cost US$11.50-US$14.72, and drug susceptibility testing (DST) cost US$44.26. Specimen transport added US$1.39-US$5.21 per sample. Assuming clinician adherence to the algorithms and perfect test accuracy, the normative cost per patient correctly diagnosed under the post-Xpert algorithms would be US$25-US$29 more per PLHIV and US$34-US$37 more per person with presumptive MDR TB (US$41 more per PLHIV when accounting for variable test sensitivity and specificity). CONCLUSIONS Xpert test unit costs could be reduced through lower cartridge prices, longer usable life of GeneXpert® (Cepheid, USA) instruments, and increased test volumes; however, epidemiological and test eligibility conditions in Cambodia limit the number of specimens received at laboratories, leading to sub-optimal utilization of current instruments. Improvements to patient referral and specimen transport could increase test volumes and reduce Xpert test unit costs in this setting.
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Affiliation(s)
- Sarah Wood Pallas
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS A-04, Atlanta, GA, 30329-4027, USA.
| | - Marissa Courey
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS A-04, Atlanta, GA, 30329-4027, USA
| | - Chhaily Hy
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention (CDC), National Institute of Public Health, #80, 289 Samdach Penn Nouth St. (289), Phnom Penh, Cambodia
| | - Wm Perry Killam
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention (CDC), National Institute of Public Health, #80, 289 Samdach Penn Nouth St. (289), Phnom Penh, Cambodia
| | - Dora Warren
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention (CDC), National Institute of Public Health, #80, 289 Samdach Penn Nouth St. (289), Phnom Penh, Cambodia
| | - Brittany Moore
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329-4027, USA
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Zhang MJ, Ren WZ, Sun XJ, Liu Y, Liu KW, Ji ZH, Gao W, Yuan B. GeneChip analysis of resistant Mycobacterium tuberculosis with previously treated tuberculosis in Changchun. BMC Infect Dis 2018; 18:234. [PMID: 29788948 PMCID: PMC5964880 DOI: 10.1186/s12879-018-3131-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/04/2018] [Indexed: 11/29/2022] Open
Abstract
Background With the widespread use of rifampicin and isoniazid, bacterial resistance has become a growing problem. Additionally, the lack of relevant baseline information for the frequency of drug-resistant tuberculosis (TB) gene mutations is a critical issue, and the incidence of this infection in the city of Changchun has not investigated to date. However, compared with the slow traditional methods of drug susceptibility testing, recently developed detection methods, such as rifampicin and isoniazid resistance-related gene chip techniques, allow for rapid, easy detection and simultaneous testing for mutation frequency and drug resistance. Methods In this study, the rifampicin and isoniazid resistance-related gene mutation chip method was employed for an epidemiological investigation. To assess the gene mutation characteristics of drug-resistant TB and evaluate the chip method, we tested 2143 clinical specimens from patients from the infectious diseases hospital of Changchun city from January to December 2016. The drug sensitivity test method was used as the reference standard. Results The following mutation frequencies of sites in the rifampicin resistance gene rpoB were found: Ser531Leu (52.6%), His526Tyr (12.3%), and Leu511Pro (8.8%). The multidrug-resistance (MDR)-TB mutation frequency was 34.7% for rpoB Ser531Leu and katG Ser315Thr, 26.4% for rpoB Ser531Leu and inhA promoter − 15 (C → T), and 10.7% for rpoB His526Tyr and katG Ser315Thr. In addition, drug susceptibility testing served as a reference standard. In previously treated clinical cases, the sensitivity and specificity of GeneChip were 83.1 and 98.7% for rifampicin resistance, 79.9 and 99.6% for isoniazid resistance, and 74.1 and 99.8% for MDR-TB. Conclusions Our experimental results show that the chip method is accurate and reliable; it can be used to detect the type of drug-resistant gene mutation in clinical specimens. Moreover, this study can be used as a reference for future research on TB resistance baselines. Electronic supplementary material The online version of this article (10.1186/s12879-018-3131-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming-Jin Zhang
- Department of Laboratory Animals, College of Animal Sciences, Jilin University, Changchun, 130062, Jilin, China.,Department of Infectious Diseases, Changchun Infectious Hospital, Changchun, 130123, Jilin, China
| | - Wen-Zhi Ren
- Department of Laboratory Animals, College of Animal Sciences, Jilin University, Changchun, 130062, Jilin, China
| | - Xue-Juan Sun
- Department of Infectious Diseases, Changchun Infectious Hospital, Changchun, 130123, Jilin, China
| | - Yang Liu
- Department of Infectious Diseases, Changchun Infectious Hospital, Changchun, 130123, Jilin, China
| | - Ke-Wei Liu
- Department of Infectious Diseases, Changchun Infectious Hospital, Changchun, 130123, Jilin, China
| | - Zhong-Hao Ji
- Department of Laboratory Animals, College of Animal Sciences, Jilin University, Changchun, 130062, Jilin, China
| | - Wei Gao
- Department of Laboratory Animals, College of Animal Sciences, Jilin University, Changchun, 130062, Jilin, China.
| | - Bao Yuan
- Department of Laboratory Animals, College of Animal Sciences, Jilin University, Changchun, 130062, Jilin, China.
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Groessl EJ, Ganiats TG, Hillery N, Trollip A, Jackson RL, Catanzaro DG, Rodwell TC, Garfein RS, Rodrigues C, Crudu V, Victor TC, Catanzaro A. Cost analysis of rapid diagnostics for drug-resistant tuberculosis. BMC Infect Dis 2018; 18:102. [PMID: 29499645 PMCID: PMC5833048 DOI: 10.1186/s12879-018-3013-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 01/30/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Growth-based drug susceptibility testing (DST) is the reference standard for diagnosing drug-resistant tuberculosis (TB), but standard time to result (TTR) is typically ≥ 3 weeks. Rapid tests can reduce that TTR to days or hours, but accuracy may be lowered. In addition to the TTR and test accuracy, the cost of a diagnostic test may affect whether it is adopted in clinical settings. We examine the cost-effectiveness of rapid diagnostics for extremely drug-resistant TB (XDR-TB) in three different high-prevalence settings. METHODS 1128 patients with confirmed TB were enrolled at clinics in Mumbai, India; Chisinau, Moldova; and Port Elizabeth, South Africa. Patient sputum samples underwent DST for first and second line TB drugs using 2 growth-based (MGIT, MODS) and 2 molecular (Pyrosequencing [PSQ], line-probe assays [LPA]) assays. TTR was the primary measure of effectiveness. Sensitivity and specificity were also evaluated. The cost to perform each test at each site was recorded and included test-specific materials, personnel, and equipment costs. Incremental cost-effectiveness ratios were calculated in terms of $/day saved. Sensitivity analyses examine the impact of batch size, equipment, and personnel costs. RESULTS Our prior results indicated that the LPA and PSQ returned results in a little over 1 day. Mean cost per sample without equipment or overhead was $23, $28, $33, and $41 for the MODS, MGIT, PSQ, and LPA, respectively. For diagnosing XDR-TB, MODS was the most accurate, followed by PSQ, and LPA. MODS was quicker and less costly than MGIT. PSQ and LPA were considerably faster but cost more than MODS. Batch size and personnel costs were the main drivers of cost variation. CONCLUSIONS Multiple factors must be weighed when selecting a test for diagnosis of XDR-TB. Rapid tests can greatly improve the time required to diagnose drug-resistant TB, potentially improving treatment success, and preventing the spread of XDR-TB. Faster time to result must be weighed against the potential for reduced accuracy, and increased costs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02170441 .
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Affiliation(s)
- Erik J. Groessl
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, #0994, San Diego, CA USA
- VA San Diego Healthcare System, San Diego, CA USA
| | - Theodore G. Ganiats
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, #0994, San Diego, CA USA
| | - Naomi Hillery
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, #0994, San Diego, CA USA
| | - Andre Trollip
- Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | | | | | | | - Valeriu Crudu
- Microbiology and Morphology Laboratory, Institute of Phthisiopneumology, Chisinau, Moldova
| | - Thomas C. Victor
- Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
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9
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The Feasibility of Xpert MTB/RIF Testing to Detect Rifampicin Resistance among Childhood Tuberculosis for Prevalence Surveys in Northern China. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5857369. [PMID: 29359155 PMCID: PMC5735616 DOI: 10.1155/2017/5857369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/17/2017] [Accepted: 11/09/2017] [Indexed: 12/22/2022]
Abstract
Drug resistance surveillance is crucial for control of drug-resistant tuberculosis (TB). However, limited data exists on the burden of drug-resistant TB in children. The goal of this work was to generate prevalence data regarding rifampicin- (RIF-) resistant childhood TB in northern China and to test the feasibility of Xpert for surveying pediatric TB drug resistance prevalence. We enrolled 362 clinically diagnosed childhood TB patients and collected sputum, gastric lavage aspirate (GLA), bronchoalveolar lavage fluid (BALF), and cerebral spinal fluid (CSF) samples. Xpert and solid culture were utilized to detect RIF resistance. The detection rate of Xpert-positive TB among new clinically diagnosed TB cases was 38.4% (139/362), significantly higher than that of solid culture-positive TB (16.3%, 59/362, P < 0.01). Notably, Xpert-positive rates differed significantly by sample type, with the highest positive rate for GLA (51.2%). The unit testing costs per RIF-resistant TB patient were $828.41 for solid culture and $761.86 for Xpert. Our data demonstrate that the prevalence of RIF resistance among childhood TB cases in our study (6.9%) is comparable to the national RIF resistance prevalence level of new cases (6.7%). In addition, Xpert is superior to the solid culture for RIF resistance survey in the childhood TB patients.
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10
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Fitzpatrick C, Hui Z, Lixia W, Renzhong L, Yunzhou R, Mingting C, Yanlin Z, Jin Z, Wei S, Caihong X, Cheng C, Alston T, Yan Q, Chengfei L, Yunting F, Shitong H, Qiang S, Scano F, Chin DP, Floyd K. Cost-effectiveness of a comprehensive programme for drug-resistant tuberculosis in China. Bull World Health Organ 2015; 93:775-84. [PMID: 26549905 PMCID: PMC4622153 DOI: 10.2471/blt.14.146274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 05/12/2015] [Accepted: 06/10/2015] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate the cost–effectiveness of a comprehensive programme for drug-resistant tuberculosis launched in four sites in China in 2011. Methods In 2011–2012, we reviewed the records of 172 patients with drug-resistant tuberculosis who enrolled in the comprehensive programme and we collected relevant administrative data from hospitals and China’s public health agency. For comparison, we examined a cohort of 81 patients who were treated for drug-resistant tuberculosis in 2006−2009. We performed a cost–effectiveness analysis, from a societal perspective, that included probabilistic uncertainty. We measured early treatment outcomes based on three-month culture results and modelled longer-term outcomes to facilitate estimation of the comprehensive programme’s cost per disability-adjusted life-year (DALY) averted. Findings The comprehensive programme cost 8837 United States dollars (US$) per patient treated. Low enrolment rates meant that some fixed costs were higher, per patient, than expected. Although the comprehensive programme appeared 30 times more costly than the previous one, it resulted in greater health benefits. The comprehensive programme, which cost US$ 639 (95% credible interval: 112 to 1322) per DALY averted, satisfied the World Health Organization’s criterion for a very cost–effective intervention. Conclusion The comprehensive programme, which included rapid screening, standardized care and financial protection, improved individual outcomes for MDR tuberculosis in a cost-effective manner. To support post-2015 global heath targets, the comprehensive programme should be expanded to non-residents and other areas of China.
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Affiliation(s)
| | - Zhang Hui
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Wang Lixia
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Li Renzhong
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Ruan Yunzhou
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Chen Mingting
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Zhao Yanlin
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Zhao Jin
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Su Wei
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Xu Caihong
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Chen Cheng
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | | | - Qu Yan
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Lv Chengfei
- Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, No 44 Wenhua Rd, Mailbox 128, Jinan, Shandong 250012, China
| | - Fu Yunting
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | | | - Sun Qiang
- Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, No 44 Wenhua Rd, Mailbox 128, Jinan, Shandong 250012, China
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