A user-friendly, open-source tool to project impact and cost of diagnostic tests for tuberculosis

Most models of infectious diseases, including tuberculosis (TB), do not provide results customized to local conditions. We created a dynamic transmission model to project TB incidence, TB mortality, multidrug-resistant (MDR) TB prevalence, and incremental costs over 5 years after scale-up of nine al...

Full description

Saved in:
Bibliographic Details
Published in:eLife 2014-06, Vol.3
Main Authors: Dowdy, David W, Andrews, Jason R, Dodd, Peter J, Gilman, Robert H
Format: Article
Language:English
Subjects:
Antibiotics, Antitubercular - economics
Clinical decision making
Computational Biology - methods
Costs
Decision Making
Decision trees
diagnostic techniques and procedures
Diagnostic tests
Diagnostic Tests, Routine - economics
Disease transmission
economic model
Epidemiology
Epidemiology and Global Health
Equilibrium
HIV
HIV Infections - complications
Human immunodeficiency virus
Humans
Incidence
infectious disease transmission
Infectious diseases
Internet
Microscopy
Models, Economic
Mortality
Multidrug resistance
Multidrug resistant organisms
Mycobacterium tuberculosis
Population
Probability
Public health
Treatment Outcome
Tuberculosis
Tuberculosis - complications
Tuberculosis - diagnosis
Tuberculosis - therapy
Tuberculosis, Multidrug-Resistant - complications
Tuberculosis, Multidrug-Resistant - diagnosis
Tuberculosis, Multidrug-Resistant - therapy
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Most models of infectious diseases, including tuberculosis (TB), do not provide results customized to local conditions. We created a dynamic transmission model to project TB incidence, TB mortality, multidrug-resistant (MDR) TB prevalence, and incremental costs over 5 years after scale-up of nine alternative diagnostic strategies. A corresponding web-based interface allows users to specify local costs and epidemiology. In settings with little capacity for up-front investment, same-day microscopy had the greatest impact on TB incidence and became cost-saving within 5 years if delivered at $10/test. With greater initial investment, population-level scale-up of Xpert MTB/RIF or microcolony-based culture often averted 10 times more TB cases than narrowly-targeted strategies, at minimal incremental long-term cost. Xpert for smear-positive TB had reasonable impact on MDR-TB incidence, but at substantial price and little impact on overall TB incidence and mortality. This user-friendly modeling framework improves decision-makers' ability to evaluate the local impact of TB diagnostic strategies.
ISSN:2050-084X
2050-084X
DOI:10.7554/eLife.02565