Imperial College London
Alternate

Professor Nimalan Arinaminpathy (Nim Pathy)

Faculty of Medicine, School of Public Health

Professor in Mathematical Epidemiology
 
 
 
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Contact

 

nim.pathy Website

 
 
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Location

 

Praed StreetSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Cilloni:2020:10.1371/journal.pmed.1003456,
author = {Cilloni, L and Arinaminpathy, N and Stagg, H and Kranzer, K},
doi = {10.1371/journal.pmed.1003456},
journal = {PLoS Medicine},
pages = {1--20},
title = {Trade-offs between cost and accuracy in active case-finding for tuberculosis: a dynamic modelling analysis},
url = {http://dx.doi.org/10.1371/journal.pmed.1003456},
volume = {17},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundActive case-finding (ACF) may be valuable in tuberculosis (TB) control, but questions remain about its optimum implementation in different settings. For example, smear microscopy misses up to half of TB cases, yet is cheap, and detects the most infectious TB cases. What, then, is the incremental value of using more sensitive and specific, yet more costly, tests such as Xpert MTB/RIF, in ACF in a high burden setting?Methods and FindingsWe constructed a dynamic transmission model of TB, calibrated to be consistent with an urban slum population in India. We applied this model to compare the potential cost and impact of two hypothetical approaches, following initial symptom screening: (i) ‘moderate accuracy’ testing employing a microscopy-like test (that is, lower cost but also lower accuracy) for bacteriological confirmation and (ii) ‘high accuracy’ testing employing an Xpert-like test (higher-cost but also higher accuracy, while also detecting rifampicin resistance).Results suggest that ACF using a moderate-accuracy test could in fact cost more overall than using a high-accuracy test. Under an illustrative budget of USD 20 million in a slum population of 2 million, high-accuracy testing would avert 1·14 (95% Bayesian credible intervals 0·75 – 1·99, with p = 0.28) cases relative to each case averted by moderate-accuracy testing. Test specificity is a key driver: high-accuracy testing would be significantly more impactful at the 5% significance level, as long as the high-accuracy test has specificity at least 3 percentage points greater than the moderate-accuracy test. Additional factors promoting the impact of a high-accuracy are that: its ability to detect rifampicin resistance can lead to long-term cost savings in second-line treatment; and its higher sensitivity contributes to the overall cases averted by ACF.Amongst limitations of this study, our cost model has a narrow focus on the commodity costs of tes
AU  - Cilloni,L
AU  - Arinaminpathy,N
AU  - Stagg,H
AU  - Kranzer,K
DO  - 10.1371/journal.pmed.1003456
EP  - 20
PY  - 2020///
SN  - 1549-1277
SP  - 1
TI  - Trade-offs between cost and accuracy in active case-finding for tuberculosis: a dynamic modelling analysis
T2  - PLoS Medicine
UR  - http://dx.doi.org/10.1371/journal.pmed.1003456
UR  - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003456
UR  - http://hdl.handle.net/10044/1/84940
VL  - 17
ER  -
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