for facilitybased systematic screening of tuberculosis among Ugandan adults Presented by Achilles Katamba O n behalf Matthew Murray Adithya Cattamanchi Claudia Denkinger Sandra ID: 1042910
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1. Cost-effectiveness of chest x-ray for facility-based systematic screening of tuberculosis among Ugandan adultsPresented by Achilles Katamba On behalf Matthew Murray, Adithya Cattamanchi, Claudia Denkinger, Sandra Kik, Anja van’t Hoog, Madhukar Pai, David Dowdywww.tb-mac.org
2. Outline of Presentation Introduction What is cost-effectiveness analysis Chest-x-ray as a triage test What is facility-based systematic screening?Cost-effectiveness methods Results Sensitivity Analysis Limitations Implications
3. Introduction TB is the #1 infectious cause of death (as of 2015)1/3 of TB patients are missed (by passive detection)Systematic screening has many advantagesHow should we find these missing three million?
4. What is cost-effectiveness?
5. Cost-effectiveness of chest x-ray for facility-based systematic screening of tuberculosis among Ugandan adults
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8. Cost-effectiveness of chest x-ray for facility-based systematic screening of tuberculosis among Ugandan adults
9. What is facility-based systematic screening?
10. What is facility-based systematic screening?
11. Cost-effectiveness of chest x-ray for facility-based systematic screening of tuberculosis among Ugandan adults
12. Cost- Effectiveness Methods
13. Parameter Types:1) Probabilities2) Diagnostic3) Cost4) Effectiveness
14. Parameter Types:1) Probabilities2) Diagnostic3) Cost4) Effectiveness5%95%
15. Parameter Types:1) Probabilities2) Diagnostic3) Cost4) Effectiveness89%11%
16. Parameter Types:1) Probabilities2) Diagnostic3) Cost4) Effectiveness$24$0
17. Parameter Types:1) Probabilities2) Diagnostic3) Cost4) EffectivenessCuredDied
18. What was the result?
19. What was the result?Chest x-ray: $610 per YLG
20. Chest x-ray: $610 ($200 - $1859) per YLG*Assuming all model parameters are correctWhat was the result?
21. Sensitivity Analysis
22. Sensitivity Analysis
23. Sensitivity Analysis
24. 3-Way Sensitivity Analysis When Triage Test =$1
25. 3-Way Sensitivity Analysis When Triage Test =$3
26. 3-Way Sensitivity Analysis When Triage Test =$5
27. 3-Way Sensitivity Analysis When Triage Test =$10
28. LimitationsIsolated to TB diagnosis and treatmentFuture transmissions prevented unaccounted forCost-effectiveness by “international standard”Use of YLG instead of DALYs
29. Implications CXR is highly cost-effective for TB screeningCan extrapolate to similar settingsScale-up can help detect missing 1/3 TB patientsR&D should focus on even better triage tests
30. Thank you! Dr. Dowdy, Dr. Cattamanchi, Dr. Denkinger, Dr. Kik, Dr. van’t Hoog, Dr. PaiDr. Bass, Dr. Friedman
31. Thank you for listening Questions/Comments