Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, Chennai-600031, India.
District TB Office, National TB Elimination Programme, Chennai.
Int Health. 2021 Dec 1;13(6):536-544. doi: 10.1093/inthealth/ihaa105.
The National Tuberculosis Elimination Programme (NTEP) of India is aiming to eliminate TB by 2025. The programme has increased its services and resources to strengthen the accurate and early detection of TB. It is important to estimate the cost of TB diagnosis in India considering the advancement and implementation of new diagnostic tools under the NTEP. The objective of this study was to estimate the unit costs of providing TB diagnostic services at different levels of public health facilities with different algorithms implemented under the NTEP in Chennai, Tamil Nadu, South India.
This costing study was conducted from the perspective of the health system. This study used only secondary data and information that were available in the public domain. Data were collected with the approval of health authorities. The patient's diagnostic path from the point of registration until the final diagnosis was considered in the costing exercise. The unit costs of different diagnostic tools used in the NTEP implemented by Chennai Corporation were calculated.
We estimated the unit cost of the eight laboratory tests (Ziehl-Neelsen [ZN], fluorescence microscopy [FM], x-ray, digital x-ray, gene Xpert MTB/RIF (cartridge-based nucleic acid amplification test [NAAT] that identifies rifampicin resistant Mycobacterium Tuberculosis) Mycobacterium Tuberculosis/Rifampicin [MTB/RIF], mycobacteria growth indicator tube [MGIT], line probe assay [LPA] and Lowenstein Jensen [LJ] culture) for diagnosis of drug-sensitive and drug-resistant TB. The unit costs included fixed and variable costs for smear examination by ZN microscopy (₹ [Indian Rupee] 326 [US${$}$4.72], FM (₹104 [US${$}$1.5]), x-ray (₹218 [US${$}$3.15]), digital X-ray (₹281 [US${$}$4.07]), gene Xpert MTB/RIF (₹1137 [US${$}$16.47]), MGIT (₹7038 [US${$}$102]), LPA (₹6448 [US${$}$93.44]) and LJ culture (₹4850 [US${$}$70.28]). Out of 10 diagnostic algorithms used for TB diagnosis, algorithms using only smear microscopy had the lowest cost, followed by smear microscopy with x-ray for drug-sensitive TB (₹104 [US${$}$1.5] to ₹544 [US${$}$7.88]). Diagnostic algorithms for drug-resistant TB involving LPA and gene Xpert MTB/RIF were the most expensive.
Understanding the various costs contributing to TB diagnosis in India provides crucial evidence for policymakers, programme managers and researchers to optimise programme spending and efficiently use resources.
印度国家结核病消除规划（NTEP）旨在到 2025 年消除结核病。该规划已经增加了服务和资源，以加强结核病的准确和早期发现。考虑到 NTEP 下新诊断工具的推进和实施，评估印度结核病诊断的成本非常重要。本研究的目的是估计在印度钦奈不同公共卫生设施不同级别下，采用 NTEP 实施的不同算法，提供结核病诊断服务的单位成本。
本成本研究从卫生系统的角度出发。本研究仅使用了公共领域可用的二级数据和信息。数据的收集获得了卫生当局的批准。在成本核算中，考虑了患者从登记点到最终诊断的整个诊断路径。计算了钦奈市实施的 NTEP 中使用的不同诊断工具的单位成本。
我们估计了八项实验室检测（Ziehl-Neelsen [ZN]、荧光显微镜[FM]、X 射线、数字 X 射线、Gene Xpert MTB/RIF（基于试剂盒的核酸扩增检测[NAAT]，可识别利福平耐药结核分枝杆菌）、结核分枝杆菌/利福平[MTB/RIF]、分枝杆菌生长指示管[MGIT]、线探针分析[LPA]和 Lowenstein Jensen [LJ]培养）用于诊断药物敏感和耐药结核病的单位成本。单位成本包括 ZN 显微镜（₹326 [US${$}$4.72]）、FM（₹104 [US${$}$1.5]）、X 射线（₹218 [US${$}$3.15]）、数字 X 射线（₹281 [US${$}$4.07]）、Gene Xpert MTB/RIF（₹1137 [US${$}$16.47]）、MGIT（₹7038 [US${$}$102]）、LPA（₹6448 [US${$}$93.44]）和 LJ 培养（₹4850 [US${$}$70.28]）的固定和可变成本。在用于结核病诊断的 10 种诊断算法中，仅使用显微镜检查的算法成本最低，其次是用于药物敏感结核病的显微镜检查加 X 射线（₹104 [US${$}$1.5]至₹544 [US${$}$7.88]）。涉及 LPA 和 Gene Xpert MTB/RIF 的耐药结核病诊断算法成本最高。
了解印度结核病诊断的各种成本有助于为政策制定者、规划管理人员和研究人员提供重要证据，以优化项目支出并有效利用资源。
