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. 2011 Jul;8(7):e1001063.
doi: 10.1371/journal.pmed.1001063. Epub 2011 Jul 26.

Is scale-up worth it? Challenges in economic analysis of diagnostic tests for tuberculosis

David W Dowdy  1 , Adithya Cattamanchi, Karen R Steingart, Madhukar Pai
Affiliations

Is scale-up worth it? Challenges in economic analysis of diagnostic tests for tuberculosis

David W Dowdy et al. PLoS Med. 2011 Jul.

Abstract

David Dowdy and colleagues discuss the complexities of costing new TB diagnostic tests, including GeneXpert, and argue that flexible analytic tools are needed for decision-makers to adapt large-sample cost-effectiveness data to local conditions.

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Conflict of interest statement

MP is co-chair of the Stop TB Partnership's New Diagnostics Working Group and a consultant for the Bill & Melinda Gates Foundation, which had no involvement in this manuscript. MP also serves as an editorial board member on PLoS Medicine. KRS serves as Coordinator for the Evidence Synthesis and Policy Subgroup of the Stop TB Partnership's New Diagnostics Working Group. All other authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Schematic decision analysis.
Decision tree for a hypothetical cost-effectiveness analysis comparing sputum smear microscopy (blue) against Xpert MTB/RIF (red). Circles represent chance nodes, where probabilities are applied to each branch as described in italics. Triangles represent terminal nodes, where costs and effectiveness are calculated. Squares demonstrate the points in the analysis at which the analytic challenges described in the text are encountered.
Figure 2
Figure 2. Process of TB diagnosis.
Boxes represent steps in the diagnostic process that must be completed for patients to experience positive clinical outcomes. Accuracy of the diagnostic test (depicted in red) plays a necessary but small role.
See this image and copyright information in PMC

References

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