Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
Int J Tuberc Lung Dis. 2013 Mar;17(3):368-72. doi: 10.5588/ijtld.12.0392.
To assess the clinical utility and cost of point-of-care Xpert® MTB/RIF for the diagnosis of smear-negative tuberculosis (TB).
Cohort study of smear-negative TB suspects at a South African primary care clinic. Participants provided one sputum sample for fluorescent smear microscopy and culture and an additional sample for Xpert. Outcomes of interest were TB diagnosis, linkage to care, patient and provider costs.
Among 199 smear-negative TB suspects, 16 were positive by Xpert, 15 by culture and 7 by microscopy. All cases identified by Xpert began anti-tuberculosis treatment the same or next day; only one of five Xpert-negative culture-positive cases started treatment after 34 days. Xpert at point of care offered similar diagnostic yield but a faster turnaround time than smear and culture performed at a centralized laboratory. Compared to smear plus culture, Xpert (at US$9.98 per cartridge) was US$3 less expensive per valid result (US$21 vs. US$24) and only US$6 more costly per case identified (US$266 vs. US$260).
Xpert is an effective method of diagnosing smear-negative TB. It is cost saving for patients, especially if performed at point of care, but it is costly for health care providers. Data-driven studies are needed to determine its cost-effectiveness in resource-poor settings with diverse diagnostic practices.
评估即时检测 Xpert® MTB/RIF 在诊断阴性痰涂片肺结核（TB）中的临床实用性和成本。
南非一家初级保健诊所的阴性痰涂片 TB 疑似患者的队列研究。参与者提供一份痰样本进行荧光涂片显微镜检查和培养，以及另一份样本进行 Xpert 检测。感兴趣的结果是 TB 诊断、与护理的联系、患者和提供者的成本。
在 199 例阴性痰涂片 TB 疑似患者中，16 例 Xpert 阳性，15 例培养阳性，7 例显微镜检查阳性。所有通过 Xpert 检测到的病例均在同一天或次日开始抗结核治疗；只有 5 例 Xpert 阴性培养阳性病例在 34 天后开始治疗。即时检测 Xpert 的诊断效果与在集中实验室进行的涂片和培养相似，但检测时间更快。与涂片加培养相比，Xpert（每盒 9.98 美元）每一个有效结果的成本降低了 3 美元（21 美元对 24 美元），每例确诊病例的成本仅增加 6 美元（266 美元对 260 美元）。
Xpert 是一种有效的诊断阴性痰涂片 TB 的方法。它为患者节省成本，特别是如果在床边进行检测，但对医疗保健提供者来说成本较高。需要进行数据驱动的研究，以确定在具有不同诊断实践的资源匮乏环境中，其成本效益。
