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The role and performance of chest X-ray for the diagnosis of tuberculosis : a cost-effectiveness analysis in Nairobi, Kenya


Document type: article
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Abstract: From TB suspects attending a chest clinic in Nairobi, Kenya, three sputum specimens were examined for ZN and culture (Lowenstein Jensen) with the objective to compare the performance and cost-effectiveness of two diagnostic pathways. From each suspect a CXR was made using a four point scoring system. Films were re-read by a reference radiologist. HIV test was performed on those who consented. Laboratory and CXR costs were used to compare for cost-effectiveness. Results: Of the 1,389 suspects enrolled, for 998 (72%) data on smear, culture and CXR was complete. 714 films were re-read, showing a 89% agreement (kappa value = 0.75 s.e.0.037) for the combined scores "TB" or "no-TB". The sensitivity/specificity of the CXR score "TB" among smear-negative suspects was 80%/67%. Using chest CXR as a screening tool in all suspects, sensitivity/ specificity of the score "any pathology" was 92%, respectively 63%. The cost per correctly diagnosed case was for the routine process $8.72, compared to $9.27 using CXR as screening tool. When costs of treatment were included, CXR followed by ZN became more cost-effective. Conclusion: The diagnostic pathway ZN followed by CXR was more cost-effective as compared to CXR followed by ZN. When cost of treatment was also considered CXR followed by ZN became more cost-effective. The low specificity of chest X-ray remains a subject of concern. Depending whether CXR was performed on all suspects or on smear-negative suspects only, 22%– 45% of patients labeled as "TB" had a negative culture. The introduction of a well-defined scoring system, clinical conferences and a system of CXR quality control can contribute to improved diagnostic performance.
Authors: Cleeff, M.R.A. van , Kivihya-Ndugga, L.E. , Meme, H. , Odhiambo, J.A. , Klatser, P.R.
Country: Kenya
Category: Research
ISSN: 1471-2334
Volume: 5
Journal: BMC Infectious Diseases
Keywords: health , disease prevention and control
Language: eng
Organization: KIT - Royal Tropical Institute
PAGE: 9
Year: 2005
Region: Africa , Africa South of Sahara , East Africa
Right: © 2005 van Cleeff et al. This article is licensed under a Creative Commons Attribution License.
Subject: Health and Nutrition
Title: The role and performance of chest X-ray for the diagnosis of tuberculosis : a cost-effectiveness analysis in Nairobi, Kenya

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