Table 1. Estimates for Model Parameters.
Parameter | Base Value | Range for Sensitivity Analysis | Source |
---|---|---|---|
TB Dynamics | |||
Probability of death, untreated smear-positive TB¹ | 0.70 | 0.50–0.95 | [37] |
Probability of death, untreated smear-negative TB | 0.20 | 0.15–0.25 | [37] |
Secondary TB infections per year, smear-positive TB | 10 | 8–12 | [38] |
Relative infectiousness of smear-negative TB | 0.22 | 0.16–0.28 | [39] |
Fraction of new TB cases that are smear-positive | 0.53 | 0.40–0.66 | [37] |
Characteristics of TB diagnosis | |||
Prevalence of active TB among persons with suspected active TB | 0.14 | 0.11–0.18 | [40] |
Sensitivity for TB | |||
Clinician diagnosis² | 0.53 | 0.40–0.67 | [31] |
Sputum smear microscopy | 0.53 | 0.34–0.65 | [41] |
IGRA³ (QuantiFERON-TB Gold) | 0.84 | 0.56–0.96 | [4] |
Xpert MTB/RIF 4 (smear-positive TB) | 0.98 | 0.97–0.99 | [18] |
Xpert MTB/RIF (smear-negative TB) | 0.67 | 0.58–0.74 | [18] |
Specificity for active TB 5 | |||
Clinician diagnosis | 0.94 | 0.75–1.00 | [42] |
Sputum smear microscopy (two smears) | 0.97 | 0.75–1.00 | [43] |
Xpert MTB/RIF | 0.98 | 0.97–0.99 | [18] |
IGRA (QuantiFERON-TB Gold) | 0.52 | 0.41–0.62 | [4] |
Xpert MTB/RIF Rif resistance | |||
Sensitivity | 0.94 | 0.87–0.97 | [18] |
Specificity | 0.98 | 0.97–0.99 | [18] |
Time to TB diagnosis (days) | |||
Sputum smear microscopy | 7 | 2.92–14.05 | [44,45] |
GeneXpert MTB/RIF | 7 | 0.50–14.05 | |
IGRA (QuantiFERON-TB Gold) | 7 | 2.92–14.05 | |
Loss to follow-up | |||
Sputum smear microscopy | 0.15 | 0.11–0.19 | [46,47] |
Xpert MTB/RIF | 0.15 | 0.11–0.19 | |
IGRA (QuantiFERON-TB Gold) | 0.15 | 0.11–0.19 | [17] |
Characteristics of TB treatment | |||
Proportion of treated TB patients who die | 0.045 | 0.033–0.056 | [31] |
Proportion of treated HIV 6 /TB patients who die | 0.090 | 0.068–0.114 | [31] |
Proportion of treated TB patients infections at 1 year | 0.045 | 0.033–0.056 | [31] |
HIV/TB | |||
HIV prevalence, general population | 0.3% | 0.225–0.4% | [48] |
HIV prevalence, patients with TB | 5.3% | 4.0–6.6% | [31] |
Proportion of HIV-infected patients with ART 7 access | 0.10 | 0.075–0.125 | [48] |
Costs and effectiveness, US Dollars (2013) | |||
Unit cost, independent laboratory | |||
Sputum smear microscopy (two smears) | $3.00 | $1-$5 | [24,49] |
Xpert MTB/RIF | $25 | $20-$57 | [50] |
IGRA (QuantiFERON-TB Gold) | $30 | $15-$50 | [27,30] |
Mean cost of treating one case of drug-susceptible TB | $66.00 | $50-$75 | [31] |
Mean cost of treating one case of MDR 8 TB | $2600 | $500-$5500 | [31] |
DALY 9 weights | |||
Active TB | 0.264 | 0.198–0.330 | [51] |
TB treatment | 0.132 | 0.099–0.165 | [17] |
Life expectancy after TB cure (years) | 40 | 30–50 | [52,53] |
1 TB, Tuberculosis
2 In the absence of any TB-specific microbiological test
3 IGRA, Interferon-Gamma Release Assay
4 MTB/RIF, Mycobacterium tuberculosis and Rifampin Resistance Testing
5 Excludes studies not performed in developing countries
6 HIV, Human Immunodeficiency Virus
7 ART, antiretroviral therapy
8 MDR, Multi-drug resistant
9 DALY, Disability-Adjusted Life Year