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A user-friendly, open-source tool to project impact and cost of diagnostic tests for tuberculosis.

Submitted by karopka on Mon, 2014/09/22 - 09:53
TitleA user-friendly, open-source tool to project impact and cost of diagnostic tests for tuberculosis.
Publication TypeJournal Article
Year of Publication2014
AuthorsDowdy, DW, Andrews, JR, Dodd, PJ, Gilman, RH
JournalElife
Paginatione02565
Date Published2014 Jun 4
ISSN2050-084X
Abstract

Most existing models of infectious diseases, including tuberculosis (TB), do not allow end-users to customize results to local conditions. We created a dynamic transmission model to project TB incidence, TB mortality, multidrug-resistant (MDR) TB prevalence, and incremental costs over five years after scale-up of nine alternative diagnostic strategies including combinations of sputum smear microscopy, Xpert MTB/RIF, microcolony-based culture, and same-day diagnosis. We developed a corresponding web-based interface that allows users to specify local costs and epidemiology. Full model code - including the ability to change any input parameter - is also included. The impact of improved diagnostic testing was greater for mortality and MDR-TB prevalence than TB incidence, and was maximized in high-incidence, low-HIV settings. More costly interventions generally had greater impact. In settings with little capacity for up-front investment, same-day microscopy had greatest impact on TB incidence and became cost-saving within five years if feasible to deliver at $10/test. In settings where more initial investment was possible, population-level scale-up of either Xpert MTB/RIF or microcolony-based culture offered substantially greater benefits, often averting ten times more TB cases than narrowly-targeted diagnostic strategies at minimal incremental long-term cost. Where containing MDR-TB is the overriding concern, Xpert for smear-positives has reasonable impact on MDR-TB incidence, but at substantial price and little impact on overall TB incidence and mortality. This novel, user-friendly modeling framework improves decision-makers' ability to evaluate the impact of TB diagnostic strategies, accounting for local conditions.

DOI10.7554/eLife.02565
Alternate JournalElife
PubMed ID24898755
PubMed Central IDPMC4082287
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