Kelly V, Sagili K D, Satyanarayana S, Reza L W, Chadha S S, Wilson N C
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
Independent Public Health Consultant, Cherambadi, Tamil Nadu, India.
Int J Tuberc Lung Dis. 2015 Jun;19(6):696-701. doi: 10.5588/ijtld.14.0203.
With support from the Stop TB Partnership's TB REACH Wave 2 Grant, diagnostic microscopy services for tuberculosis (TB) were upgraded from conventional Ziehl-Neelsen (ZN) based sputum microscopy to light emitting diode technology-based fluorescence microscopy (LED FM) in 200 high-workload microscopy centres in India as a pilot intervention.
To evaluate the cost-effectiveness of LED-FM over conventional ZN microscopy to inform further scale-up.
A decision-tree model was constructed to assess the cost utility of LED FM over ZN microscopy. The results were summarised using incremental cost-effectiveness ratio (ICER); one-way and probabilistic sensitivity analyses were also conducted to address uncertainty within the model. Data were analysed from 200 medical colleges in 2011 and 2012, before and after the introduction of LED microscopes. A full costing analysis was carried out from the perspective of a national TB programme.
The ICER was calculated at US$14.64 per disability-adjusted life-year, with an 82% probability of being cost-effective at a willingness-to-pay threshold equivalent to Indian gross domestic product per capita.
LED FM is a cost-effective intervention for detecting TB cases in India at high-workload medical college settings.
在遏制结核病伙伴关系的结核病防治拓展项目第二阶段赠款的支持下，印度200个高工作量显微镜检测中心的结核病诊断显微镜检测服务从基于传统萋尼氏（ZN）法的痰涂片显微镜检测升级为基于发光二极管技术的荧光显微镜检测（LED - FM），作为一项试点干预措施。
评估LED - FM相对于传统ZN显微镜检测的成本效益，为进一步扩大规模提供依据。
构建决策树模型以评估LED - FM相对于ZN显微镜检测的成本效用。结果采用增量成本效益比（ICER）进行总结；还进行了单因素和概率敏感性分析以解决模型中的不确定性。分析了2011年和2012年引入LED显微镜前后200所医学院的数据。从国家结核病规划的角度进行了全面成本分析。
计算得出ICER为每获得一个伤残调整生命年14.64美元，在相当于印度人均国内生产总值的支付意愿阈值下具有成本效益的概率为82%。
在印度高工作量医学院环境中，LED - FM是检测结核病病例的一种具有成本效益的干预措施。
