Evaluation of screening strategies for pulmonary tuberculosis among hospitalized patients in a low-burden setting: cost-effectiveness of GeneXpert MTB/RIF compared to smear microscopy

Objective:Hospitalized patients undergoing evaluation for pulmonary tuberculosis (TB) require airborne isolation while testing for Mycobacterium tuberculosis (MTB) to reduce risk of nosocomial transmission. GeneXpert MTB/RIF (Xpert) is more rapid and accurate than sputum smear microscopy, but it is...

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Vydané v:	Infection control and hospital epidemiology Ročník 43; číslo 7; s. 892 - 897
Hlavní autori:	Hickey, Andrew J., Cummings, Matthew J., Zafari, Zafar, Louh, Irene K., Li, Jianhua, O’Donnell, Max R.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	New York, USA Cambridge University Press 01.07.2022
Predmet:	Age Chronic obstructive pulmonary disease Cost analysis Cost control Diabetes Evaluation HIV Hospitalization Hospitals Human immunodeficiency virus Immune system Infections Kidney diseases Length of stay Medical records Microscopy Monte Carlo simulation Nosocomial infection Original Article Patients Pneumonia Regression analysis Risk reduction Socioeconomic factors Software Tuberculosis New York United States > US airborne isolation Cost-effectiveness tuberculosis GeneXpert MTB/RIF length-of-stay
ISSN:	0899-823X, 1559-6834, 1559-6834
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Abstract	Objective:Hospitalized patients undergoing evaluation for pulmonary tuberculosis (TB) require airborne isolation while testing for Mycobacterium tuberculosis (MTB) to reduce risk of nosocomial transmission. GeneXpert MTB/RIF (Xpert) is more rapid and accurate than sputum smear microscopy, but it is not routinely used to ‘rule out’ infectious pulmonary TB among hospitalized patients in the United States. We sought to evaluate the diagnostic performance and cost-effectiveness of Xpert-based TB evaluation.Methods:We conducted a retrospective cohort study of hospitalized adults evaluated for pulmonary TB at a large academic medical center in New York from 2010 to 2017. Using propensity score matching, we compared hospital length-of-stay among patients undergoing conventional smear-based TB evaluation to a control group with non-TB pneumonia. We performed a probabilistic cost-effectiveness analysis to compare Xpert-based versus conventional TB evaluation.Results:In total 1,421 patients were evaluated for TB with airborne isolation and sputum testing; mycobacterial culture was positive for MTB in 49 (3.4%). Conventional TB evaluation was associated with an increase of 4.4 hospital days compared to propensity-matched controls. Xpert-based testing strategies dominated conventional TB evaluation with a cost savings of $5,947 (95% CI, $1,156–$12,540) and $4,445 (95% CI, $696–$9,526) per patient depending on the number of Xpert tests performed (1 vs 2, respectively) and assumptions about the reduction of length of stay achieved.Conclusions:In the evaluation of hospitalized patients for pulmonary TB, Xpert-based testing has superior diagnostic performance and is likely cost-effective compared to smear microscopy due to reduced hospital length-of-stay associated with more rapid test results.
AbstractList	Objective:Hospitalized patients undergoing evaluation for pulmonary tuberculosis (TB) require airborne isolation while testing for Mycobacterium tuberculosis (MTB) to reduce risk of nosocomial transmission. GeneXpert MTB/RIF (Xpert) is more rapid and accurate than sputum smear microscopy, but it is not routinely used to ‘rule out’ infectious pulmonary TB among hospitalized patients in the United States. We sought to evaluate the diagnostic performance and cost-effectiveness of Xpert-based TB evaluation.Methods:We conducted a retrospective cohort study of hospitalized adults evaluated for pulmonary TB at a large academic medical center in New York from 2010 to 2017. Using propensity score matching, we compared hospital length-of-stay among patients undergoing conventional smear-based TB evaluation to a control group with non-TB pneumonia. We performed a probabilistic cost-effectiveness analysis to compare Xpert-based versus conventional TB evaluation.Results:In total 1,421 patients were evaluated for TB with airborne isolation and sputum testing; mycobacterial culture was positive for MTB in 49 (3.4%). Conventional TB evaluation was associated with an increase of 4.4 hospital days compared to propensity-matched controls. Xpert-based testing strategies dominated conventional TB evaluation with a cost savings of $5,947 (95% CI, $1,156–$12,540) and $4,445 (95% CI, $696–$9,526) per patient depending on the number of Xpert tests performed (1 vs 2, respectively) and assumptions about the reduction of length of stay achieved.Conclusions:In the evaluation of hospitalized patients for pulmonary TB, Xpert-based testing has superior diagnostic performance and is likely cost-effective compared to smear microscopy due to reduced hospital length-of-stay associated with more rapid test results. Hospitalized patients undergoing evaluation for pulmonary tuberculosis (TB) require airborne isolation while testing for Mycobacterium tuberculosis (MTB) to reduce risk of nosocomial transmission. GeneXpert MTB/RIF (Xpert) is more rapid and accurate than sputum smear microscopy, but it is not routinely used to 'rule out' infectious pulmonary TB among hospitalized patients in the United States. We sought to evaluate the diagnostic performance and cost-effectiveness of Xpert-based TB evaluation.OBJECTIVEHospitalized patients undergoing evaluation for pulmonary tuberculosis (TB) require airborne isolation while testing for Mycobacterium tuberculosis (MTB) to reduce risk of nosocomial transmission. GeneXpert MTB/RIF (Xpert) is more rapid and accurate than sputum smear microscopy, but it is not routinely used to 'rule out' infectious pulmonary TB among hospitalized patients in the United States. We sought to evaluate the diagnostic performance and cost-effectiveness of Xpert-based TB evaluation.We conducted a retrospective cohort study of hospitalized adults evaluated for pulmonary TB at a large academic medical center in New York from 2010 to 2017. Using propensity score matching, we compared hospital length-of-stay among patients undergoing conventional smear-based TB evaluation to a control group with non-TB pneumonia. We performed a probabilistic cost-effectiveness analysis to compare Xpert-based versus conventional TB evaluation.METHODSWe conducted a retrospective cohort study of hospitalized adults evaluated for pulmonary TB at a large academic medical center in New York from 2010 to 2017. Using propensity score matching, we compared hospital length-of-stay among patients undergoing conventional smear-based TB evaluation to a control group with non-TB pneumonia. We performed a probabilistic cost-effectiveness analysis to compare Xpert-based versus conventional TB evaluation.In total 1,421 patients were evaluated for TB with airborne isolation and sputum testing; mycobacterial culture was positive for MTB in 49 (3.4%). Conventional TB evaluation was associated with an increase of 4.4 hospital days compared to propensity-matched controls. Xpert-based testing strategies dominated conventional TB evaluation with a cost savings of $5,947 (95% CI, $1,156-$12,540) and $4,445 (95% CI, $696-$9,526) per patient depending on the number of Xpert tests performed (1 vs 2, respectively) and assumptions about the reduction of length of stay achieved.RESULTSIn total 1,421 patients were evaluated for TB with airborne isolation and sputum testing; mycobacterial culture was positive for MTB in 49 (3.4%). Conventional TB evaluation was associated with an increase of 4.4 hospital days compared to propensity-matched controls. Xpert-based testing strategies dominated conventional TB evaluation with a cost savings of $5,947 (95% CI, $1,156-$12,540) and $4,445 (95% CI, $696-$9,526) per patient depending on the number of Xpert tests performed (1 vs 2, respectively) and assumptions about the reduction of length of stay achieved.In the evaluation of hospitalized patients for pulmonary TB, Xpert-based testing has superior diagnostic performance and is likely cost-effective compared to smear microscopy due to reduced hospital length-of-stay associated with more rapid test results.CONCLUSIONSIn the evaluation of hospitalized patients for pulmonary TB, Xpert-based testing has superior diagnostic performance and is likely cost-effective compared to smear microscopy due to reduced hospital length-of-stay associated with more rapid test results.
Author	O’Donnell, Max R. Hickey, Andrew J. Louh, Irene K. Zafari, Zafar Li, Jianhua Cummings, Matthew J.
Author_xml	– sequence: 1 givenname: Andrew J. surname: Hickey fullname: Hickey, Andrew J. organization: 1Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York – sequence: 2 givenname: Matthew J. surname: Cummings fullname: Cummings, Matthew J. organization: 1Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York – sequence: 3 givenname: Zafar surname: Zafari fullname: Zafari, Zafar organization: 2Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland – sequence: 4 givenname: Irene K. surname: Louh fullname: Louh, Irene K. organization: 1Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York – sequence: 5 givenname: Jianhua surname: Li fullname: Li, Jianhua organization: 3Department of Medicine, Columbia University Irving Medical Center, New York, New York – sequence: 6 givenname: Max R. surname: O’Donnell fullname: O’Donnell, Max R. email: mo2130@cumc.columbia.edu organization: 1Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
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Cites_doi	10.1001/jama.1992.03480190074035 10.1093/cid/ciu620 10.1056/NEJM199201233260404 10.1093/cid/ciw694 10.1056/NEJMoa0907847 10.1093/cid/ciw035 10.1016/j.diagmicrobio.2005.02.014 10.1371/journal.pone.0079669 10.1016/0140-6736(92)92601-B 10.1086/671732 10.1093/cid/ciu212 10.1164/rccm.200803-381OC 10.1001/jamainternmed.2018.3638 10.5588/ijtld.13.0095 10.1086/518656 10.1164/rccm.201804-0654OC
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SubjectTerms	Age Chronic obstructive pulmonary disease Cost analysis Cost control Diabetes Evaluation HIV Hospitalization Hospitals Human immunodeficiency virus Immune system Infections Kidney diseases Length of stay Medical records Microscopy Monte Carlo simulation Nosocomial infection Original Article Patients Pneumonia Regression analysis Risk reduction Socioeconomic factors Software Tuberculosis
Title	Evaluation of screening strategies for pulmonary tuberculosis among hospitalized patients in a low-burden setting: cost-effectiveness of GeneXpert MTB/RIF compared to smear microscopy
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