A cost effectiveness analysis of different ways of analyzing sputum for turberculosis diagnosis: direct smear microscopy, natural sedimentation and centrifugation

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dc.contributor.advisorSinanovic, Edinaen_ZA
dc.contributor.authorPhiri, Mafayo Cen_ZA
dc.date.accessioned2014-11-08T18:05:11Z
dc.date.available2014-11-08T18:05:11Z
dc.date.issued2009en_ZA
dc.descriptionIncludes bibliographical references.en_ZA
dc.description.abstractIn Malawi, sputum smear microscopy (Ziehl-Neelsen) is a major diagnostic technique for pulmonary tuberculosis (TB). Though relatively rapid, it tends to be poorly sensitive since it requires a large number of organisms to be present in the specimen before they can be detected. Two approaches that improve sensitivity of direct smear microscopy are sputum liquefaction with chemicals such as sodium hypochlorite (household bleach) and subsequent concentration with gravity (natural) sedimentation and centrifugation. This study estimated the costs and cost-effectiveness of these techniques in processing sputum for detecting new cases of pulmonary tuberculosis in Malawi. Bleach natural sedimentation and bleach centrifugation methods were compared with direct smear microscopy. Cost and effectiveness data were collected from a randomized controlled trial from one major TB health facility. Effectiveness was determined by number of smear positive TB cases detected by each method. Cost-effectiveness was estimated from a provider's perspective in terms of cost per TB cases diagnosed and cost per smear positive TB case detected. Cost per positive TB case detected was least in natural (gravity) sedimentation (US $9.35), compared to centrifugation (US $11.48) and direct smear microscopy (US $15.93). The study findings indicate that natural sedimentation can significantly reduce cost of sputum processing. There is a strong economic case supporting the use of natural sedimentation for diagnosing tuberculosis in Malawi. In addition, bleach digests sputum making it less infectious and easy to work with thereby increasing the safety of specimens to clinicians. Therefore, introducing natural sedimentation technique would not only reduce costs but also improve safety to health workers.en_ZA
dc.identifier.apacitationPhiri, M. C. (2009). <i>A cost effectiveness analysis of different ways of analyzing sputum for turberculosis diagnosis: direct smear microscopy, natural sedimentation and centrifugation</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Health Economics Unit. Retrieved from http://hdl.handle.net/11427/9415en_ZA
dc.identifier.chicagocitationPhiri, Mafayo C. <i>"A cost effectiveness analysis of different ways of analyzing sputum for turberculosis diagnosis: direct smear microscopy, natural sedimentation and centrifugation."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Health Economics Unit, 2009. http://hdl.handle.net/11427/9415en_ZA
dc.identifier.citationPhiri, M. 2009. A cost effectiveness analysis of different ways of analyzing sputum for turberculosis diagnosis: direct smear microscopy, natural sedimentation and centrifugation. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Phiri, Mafayo C AB - In Malawi, sputum smear microscopy (Ziehl-Neelsen) is a major diagnostic technique for pulmonary tuberculosis (TB). Though relatively rapid, it tends to be poorly sensitive since it requires a large number of organisms to be present in the specimen before they can be detected. Two approaches that improve sensitivity of direct smear microscopy are sputum liquefaction with chemicals such as sodium hypochlorite (household bleach) and subsequent concentration with gravity (natural) sedimentation and centrifugation. This study estimated the costs and cost-effectiveness of these techniques in processing sputum for detecting new cases of pulmonary tuberculosis in Malawi. Bleach natural sedimentation and bleach centrifugation methods were compared with direct smear microscopy. Cost and effectiveness data were collected from a randomized controlled trial from one major TB health facility. Effectiveness was determined by number of smear positive TB cases detected by each method. Cost-effectiveness was estimated from a provider's perspective in terms of cost per TB cases diagnosed and cost per smear positive TB case detected. Cost per positive TB case detected was least in natural (gravity) sedimentation (US $9.35), compared to centrifugation (US $11.48) and direct smear microscopy (US $15.93). The study findings indicate that natural sedimentation can significantly reduce cost of sputum processing. There is a strong economic case supporting the use of natural sedimentation for diagnosing tuberculosis in Malawi. In addition, bleach digests sputum making it less infectious and easy to work with thereby increasing the safety of specimens to clinicians. Therefore, introducing natural sedimentation technique would not only reduce costs but also improve safety to health workers. DA - 2009 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2009 T1 - A cost effectiveness analysis of different ways of analyzing sputum for turberculosis diagnosis: direct smear microscopy, natural sedimentation and centrifugation TI - A cost effectiveness analysis of different ways of analyzing sputum for turberculosis diagnosis: direct smear microscopy, natural sedimentation and centrifugation UR - http://hdl.handle.net/11427/9415 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/9415
dc.identifier.vancouvercitationPhiri MC. A cost effectiveness analysis of different ways of analyzing sputum for turberculosis diagnosis: direct smear microscopy, natural sedimentation and centrifugation. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Health Economics Unit, 2009 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/9415en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentHealth Economics Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherHealth Economicsen_ZA
dc.titleA cost effectiveness analysis of different ways of analyzing sputum for turberculosis diagnosis: direct smear microscopy, natural sedimentation and centrifugationen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMPHen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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