– Cost Effectiveness Analysis of Microscopic Observation Drug Susceptibility Assay Versus Genexpert Mtb/ Rif In The Diagnosis of Pulmonary Tuberculosis In Hiv Patients –
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TABLE OF CONTENTS
DECLARATION …………….. ii
ACKNOWLEDGEMENT…………. iv
LIST OF TABLES………………. vii
LIST OF FIGURES…………. viii
ACRONYMS ………….. ix
SUMMARY……………… xi
CHAPTER ONE
INTRODUCTION……………1
1.1 BACKGROUND INFORMATION……………….1
1.2 PROBLEM STATEMENT…………4
1.3 JUSTIFICATION FOR THE STUDY………..6
1.4 RESEARCH QUESTIONS………….8
1.5 OBJECTIVES ………………8
1.5.1 GENERAL OBJECTIVE: ………….8
1.5.2 SPECIFIC OBJECTIVES:……….8
CHAPTER TWO
LITERATURE REVIEW…………………9
2.1 MYCOBACTERIUM TUBERCULOSIS …………9
2.2 GLOBAL TB CONTROL…………….10
2.3 EPIDEMIOLOGY OF HIV ASSOCIATED TB………….11
2.4 PATHOGENESIS OFHIV ASSOCIATED TB………13
2.5 OVERVIEW OF TRADITIONAL TB DIAGNOSTICS …….14
2.5.1 MICROSCOPY………………14
2.5.2 CHEST X-RAY……………15
2.5.3 SOLID CULTURE ………16
2.6 OVERVIEW OF NEW TB DIAGNOSTICS ……….17
2.6.1 GENEXPERT MTB/RIF TEST………..17
2.6.2 MODS ASSAY ………….18
2.7 KEY ECONOMIC CONCEPTS…………20
2.7.1 SCARCITY AND OPPORTUNITY COST ………20
2.7.2 ECONOMIC EVALUATION……..20
2.7.3 COST-BENEFIT ANALYSIS …………….21
2.7.4 COST-EFFECTIVENESS ANALYSIS……..21
2.7.5 COST-UTILITY ANALYSIS ………….22
2.7.6 DECISION ANALYSIS MODELING………..22
2.7.8 DECISION TREES ……….23
2.7.9 COST MEASUREMENT ……………….24
2.7.10 COST IN ECONOMIC EVALUATION……………..25
2.7.11 COST ANALYSIS …..25
2.7.12 UTILITY MAXIMIZATION AND WILLINGNESS-TO-PAY ………25
2.7.13 TIME PREFERENCE (DISCOUNTING)…….26
2.7.14 THE INCREMENTAL COST-EFFECTIVENESS RATIO……….26
2.7.15 SENSITIVITY ANALYSIS……..27
2.7.16 DETERMINISTIC SENSITIVITY ANALYSIS …….28
2.7.17 PROBABILISTIC SENSITIVITY ANALYSIS………29
2.8 EMPIRIC REVIEW OF COST EFFECTIVENESS OF NOVEL DIAGNOSTICS FOR TB DIAGNOSIS…….29
2.8.1 COST ANALYSIS/ UNIT COSTS OF MODS/ GENEXPERT……..29
2.8.2 COST EFFECTIVENESS OF MODS/GENEXPERT………29
CHAPTER THREE
METHODOLOGY ………..33
3.1 PROJECT SCOPE/DESIGN………33
3.2 MODEL DESCRIPTION………………..33
3.3 STUDY AREA/SETTING…………34
3.4 COSTING STUDY …………34
3.5 EPIDEMIOLOGICAL INPUT PARAMETERS …………38
3.6 COST EFFECTIVENESS ANALYSIS…………….38
3.6.1 SENSITIVITY ANALYSIS……………..39
3.7 DATA MANAGEMENT AND ANALYSIS ……………..39
CHAPTER FOUR
RESULTS ……..40
4.1 COST ANALYSIS………40
4.1 COST EFFECTIVENESS ………42
4.3 SENSITIVITY ANALYSIS……45
CHAPTER FIVE
DISCUSSION……….47
CHAPTER SIX
CONCLUSIONS AND RECOMMENDATIONS……50
6.1 CONCLUSION………50
6.2 RECOMMENDATION ……….51
References ……52
INTRODUCTION
BACKGROUND INFORMATION
Tuberculosis (TB) is a highly infectious caused by the bacterium Mycobacterium tuberculosis (MTB).
It most commonly affects the lungs (pulmonary TB) but may also affect other parts of the body such as the spine, lymph nodes, brain, bone joints, meninges and kidneys (extra-pulmonary TB).
TB is a . Globally, 9.6 million new cases of TB occurred in 2014 with 1.5million TB deaths.2 HIV infection is the most significant risk factor for the development of TB.
This is because HIV causes the reactivation of latent TB and predisposes infected individuals to acquire . TB on the other hand, is also known to accelerate HIV infection into AIDS.
This is one of the reasons why results in greater morbidity andmortality.3,4 People living with HIV are 26 times (20 – 30) more likely to develop than those who are HIV negative.5,6 Of the estimated 9.6 million incident TB patients in 2014,12% (1.2 of 9.6 million) are infected with HIV.
References
Lawn, S. D. et al. Tuberculosis. Lancet (London, England)378, 57–72 (2011).
World Health Organization. Global tuberculosis report 2015. (2015).
Reid, M. J. A. & Shah, N. S. Approaches to tuberculosis screening and diagnosis in people with HIV in resource-limited settings. Lancet. Infect. Dis.9, 173–84 (2009).
Lawn, S. D., Harries, A. D. & Wood, R. Strategies to reduce early morbidity and mortality
in adults receiving antiretroviral therapy in resource-limited settings. Curr. Opin. HIV
AIDS5, 18–26 (2010).Millet, J. P. et al. Factors that influence current tuberculosis epidemiology. Eur. Spine J.22, (2013).
Guimaraes, R. M., Lobo, A. de P., Siqueira, E. A., Borges, T. F. F. & Melo, S. C. C. Tuberculosis, HIV, and poverty: temporal trends in Brazil, the Americas, and worldwide. J. Bras. Pneumol.38, 511–517 (2012).