손호준 교수

Our results suggest that Xpert is a cost-effective method of TB diagnosis, compared to a base case of smear microscopy and clinical diagnosis of smear-negative TB in low- and middle-income settings where, with its ability to substantially increase case finding, it has important potential for improving TB diagnosis and control. The extent of cost-effectiveness gain to TB programmes from deploying Xpert is primarily dependent on current TB diagnostic practices. Further work is required during scal

In evaluating public health interventions in resource-limited settings, accounting for implementation costs enables more realistic estimates of budget impact and cost-effectiveness and provides important insights into program feasibility, scale-up, and sustainability. Assessment of implementation costs should be planned prospectively and performed in a standardized manner to ensure generalizability.

Our findings suggest limited potential impact of Xpert testing in high-resource, low-incidence ambulatory settings due to lower sensitivity in the context of less extensive disease, and limited potential to expedite diagnosis beyond what is achieved with the existing, well-performing diagnostic algorithm.

Tuberculosis continues to be a major global health problem. Lack of accurate, rapid and cost-effective diagnostic tests poses a huge obstacle to global TB control. While several new diagnostic tools are being developed and evaluated for TB, it is important that new tools are introduced for widespread use only after careful validation of accuracy, impact as well as cost-effectiveness in real-world settings. While there are large numbers of studies on the accuracy of TB diagnostic tests, there are

Our findings indicate that the use of World Health Organization recommended diagnostics for TB reduced delays in diagnosing and initiating TB treatment. Future studies evaluating performance and impact of diagnostics should consider reporting time delay estimates based on the standardized reporting framework.

A one-time comprehensive ACF intervention simultaneously operating in public health clinics and corresponding catchment communities can have important medium-term impact on case-finding and be cost-effective in Zambia. The value of such interventions increases if targeted to populations with high HIV/TB mortality, substantial barriers (both behavioral and physical) to care-seeking exist, and when ACF interventions can optimize screening by achieving operational efficiency.

Decentralization of Xpert testing is likely to be cost-saving or cost-effective in most settings to which these simulation results might generalize. More decentralized testing is more cost-effective in settings with moderate-to-high peripheral testing volumes, high existing clinical LTFU, inability to share specimen transport costs with other disease entities, and ability to ensure high-quality peripheral Xpert testing. Decision-makers should assess these factors when deciding whether to decentr

The National Heart, Lung, and Blood Institute.

Active case-finding (ACF) is an important component of the End TB Strategy. However, ACF is resource-intensive, and the economics of ACF are not well-understood. Data on the costs of ACF are limited, with little consistency in the units and methods used to estimate and report costs. Mathematical models to forecast the long-term effects of ACF require empirical measurements of the yield, timing and costs of case detection. Pragmatic trials offer an opportunity to assess the cost-effectiveness of

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: Primary objectives Review question A: To obtain summary estimates of the diagnostic accuracy of Xpert MTB/RIF for the diagnosis of pulmonary TB, using solid or liquid culture as a reference standard. Purpose of index test: A.1 Xpert MTB/RIF as a replacement test for smear microscopy. A.2. Xpert MTB/RIF as an add‐on test after smear microscopy. Review question B: To obtain summary estimates of the

Results from two contextually and programmatically different multi-component ACF programs demonstrate that our tool is fully capable of comprehensively and transparently evaluating and comparing costs of various ACF programs.

Ziehl-Neelsen (ZN) microscopy is the primary method for acid-fast bacilli examination in resource-limited settings, including Thailand. Despite its considerably improved diagnostic performance, conventional fluorescent microscopy (FM) is rarely used due to its perceived high cost. An evaluation in Thailand found that the total cost of FM operated in the National Tuberculosis Reference Laboratory (NTRL) in Bangkok, Thailand, is similar to that of ZN performed in the NTRL and in four regional Thai

Xpert test and outreach program costs within and across study sites were mainly driven by the dynamics of Xpert testing demand resulting from the combined outreach activities. However, these increases in demand required considerable overtime work resulting in additional costs and operational challenges at the study laboratories. Therefore, careful laboratory operational adjustment should be evaluated at target areas in parallel to the anticipated demand from the Xpert referral outreach program s

The TST-alone strategy was the most cost-effective; the QFT-GIT-alone strategy averted the greatest number of TB cases but incurred the highest cost in contact investigation for school TB outbreaks.