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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The role and performance of chest X-ray for the diagnosis of tuberculosis: A cost-effective analysis in Nairobi, Kenya
BMC Infectious Diseases, Volume 5, Article 111, Year 2005
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Description
Background: The objective of this study was to establish 1) the performance of chest X-ray (CXR) in all suspects of tuberculosis (TB), as well as smear-negative TB suspects and 2) to compare the cost-effectiveness of the routine diagnostic pathway using Ziehl-Neelsen (ZN) sputum microscopy followed by CXR if case of negative sputum result (ZN followed by CXR) with an alternative pathway using CXR as a screening tool (CXR followed by ZN). Methods: From TB suspects attending a chest clinic in Nairobi, Kenya, three sputum specimens were examined for ZN and culture (Lowenstein Jensen). Culture was used as gold standard. From each suspect a CXR was made using a four point scoring system: i: no pathology, ii: pathology not consistent for TB, iii: pathology consistent for TB and iv: pathology highly consistent for TB. The combined score i + ii was labeled as "no TB" and the combined score iii + iv was labeled as "TB". 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. Conclusions: The diagnostic pathway ZN followed by CXR was more cost-effective as compared to CXR followed by ZN. When cost oftreatment 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. © 2005 van Cleeff et al., licensee BioMed Central Ltd.
Authors & Co-Authors
van Cleeff, Maarten R.A.
Netherlands, The Hague
Kncv Tuberculosis Foundation
Kivihya-Ndugga, Lydia E.A.
Kenya, Nairobi
Kenya Medical Research Institute
Meme, Hellen K.
Kenya, Nairobi
Kenya Medical Research Institute
Stewart, Alistair W.
Kenya, Nairobi
Kenya Medical Research Institute
Kenya, Kisumu
Centers for Disease Control and Prevention, Kenya
Klatser, Paul R.
Netherlands, Amsterdam
Royal Tropical Institute - Kit
Statistics
Citations: 158
Authors: 5
Affiliations: 4
Identifiers
Doi:
10.1186/1471-2334-5-111
ISSN:
14712334
e-ISSN:
14712334
Research Areas
Health System And Policy
Infectious Diseases
Study Locations
Kenya