Navegando por Autor "Kritski, Afrânio Lineu"
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Item Cost analysis for patients with presumed pulmonary tuberculosis attended in the public health system of Rio de Janeiro, Brazil.(2022) Vater, Maria Cláudia; Maximo, Mário Motta; Moreira, Adriana da Silva Rezende; Silva, Suely Conceição Alves da; Almeida, Isabela Neves de; Kritski, Afrânio LineuBackground: In last years, few attention has given to the patient’s prediagnostic costs when evaluating the introduction of new technologies for tuberculosis (TB) and in this context, this study evaluated patient’s costs and cost‑effectiveness incurred with TB diagnosis comparing BactecTMMGITTM960 system (MGIT) to the Löwestein–Jensen (LJ) culture in a health center and in a university hospital, in Rio de Janeiro City, Brazil. Methods: Patient’s mean costs were evaluated during the diagnosis process and cost‑effectiveness based on mean time in days for the adoption of appropriate clinical anti‑TB treatment in two health units comparing culture by means LJ and MGIT. Results: The mean cost of LJ and MGIT in the health center was U. S. dollars (US$) 26.6 and US$ 45.13, respectively, and in university hospital was US$ 206.87 and US$ 285.48, respectively. Comparing the two approaches for TB diagnosis incurred by the patients, the incremental cost‑effectiveness of MGIT compared to LJ was US$ 0.88 and US$ 4.03 per patient, respectively, to reduce the average time to adopt appropriate treatment. Conclusions: The culture method directly impacts patient costs while waiting for the correct diagnosis and contributing to aggravating costs with patients with TB.Item Cost analysis of smear microscopy and the Xpert assay for tuberculosis diagnosis : average turnaround time.(2020) Figueredo, Lida Jouca de Assis; Miranda, Silvana Spíndola de; Santos, Lucas Benício dos; Manso, Caroline Gontijo Gonçalves; Soares, Valéria Martins; Alves, Suely; Vater, Maria Cláudia; Kritski, Afrânio Lineu; Carvalho, Wânia da Silva; Pádua, Cristiane Menezes de; Almeida, Isabela Neves deIntroduction: Rapid and accurate tuberculosis detection is critical for improving patient diagnosis and decreasing tuberculosis transmission. Molecular assays can significantly increase laboratory costs; therefore, the average time and economic impact should be evaluated before implementing a new technology. The aim of this study was to evaluate the cost and average turnaround time of smear microscopy and Xpert assay at a university hospital. Methods: The turnaround time and cost of the laboratory diagnosis of tuberculosis were calculated based on the mean cost and activity based costing (ABC). Results: The average turnaround time for smear microscopy was 16.6 hours while that for Xpert was 24.1 hours. The Xpert had a mean cost of USD 17.37 with an ABC of USD 10.86, while smear microscopy had a mean cost of USD 13.31 with an ABC of USD 6.01. The sensitivity of smear microscopy was 42.9% and its specificity was 99.1%, while the Xpert assay had a sensitivity of 100% and a specificity of 96.7%. Conclusions: The Xpert assay has high accuracy; however, the turnaround time and cost of smear microscopy were lower than those of Xpert.Item Cost-effectiveness of Xpert®MTB/RIF in the diagnosis of tuberculosis : pragmatic study.(2021) Silva, Suely Conceição Alves da; Vater, Maria Cláudia; Ramalho, Daniela Maria de Paula; Almeida, Isabela Neves de; Miranda, Silvana Spíndola de; Kritski, Afrânio LineuIntroduction: The intensification of research and innovation with the creation of networks of rapid and effective molecular tests as strategies for the end of tuberculosis are essential to avoid late diagnosis and for the eradication of the disease. We aimed to evaluate the cost-effectiveness of Xpert®MTB/RIF (Xpert) in the diagnosis of drug-resistant tuberculosis in reference units, in scenarios with and without subsidies, and the respective cost adjustment for today. Methods: The analyses were performed considering as criterion of effectiveness, negative culture or clinical improvement in the sixth month of follow-up. The comparison was performed using two diagnostic strategies for the drug susceptibility test (DST), BactecTMMGITTM960 System, versus Xpert. The cost effectiveness and incremental cost-effectiveness ratio (ICER) were calculated and dollar-corrected for American inflation (US$ 1.00 = R$ 5,29). Results: Subsidized Xpert had the lowest cost of US$ 33.48 (R$67,52) and the highest incremental average efficiency (13.57), thus being a dominated analysis. After the inflation was calculated, the mean cost was DST-MGIT=US$ 74.85 (R$ 396,73) and Xpert = US$ 37.33 (R$197,86) with subsidies. Conclusions: The Xpert in the diagnosis of TB-DR in these reference units was cost-effective with subsidies. In the absence of a subsidy, Xpert in TB-DR is not characterized as cost effective. This factor reveals the vulnerability of countries dependent on international organizations’ subsidy policies.Item Detection of drug resistant mycobacterium tuberculosis strains using Kit SIRE Nitratase® : a multicenter study.(2020) Miranda, Silvana Spindola de; Almeida, Isabela Neves de; Mansur, Maria de Fátima Filardi Oliveira; Figueredo, Lida Jouca de Assis; Carvalho, Wânia da Silva; Hadaad, João Paulo Amaral; Diniz, Jaciara de Lourdes do Carmo Guimarães; Groll, Andrea von; Silva, Pedro Almeida da; Lopes, Maria Luiza; Santos, Marcelo Cordeiro dos; Brito, Alexandra; Mello, Fernanda Carvalho de Queiroz; Malaquias, Thiago da Silva Santos; Croda, Julio; Pinhata, Juliana Maira Watanabe; Oliveira, Rosângela Siqueira de; Chimara, Erica; Rossetti, Maria Lúcia; Halon, Maria Laura; Lourenço, Maria Cristina; Medeiros, Reginalda Ferreira de Melo; Montes, Fátima Cristina Onofre Fandinho; Machado, Diana; Viveiros, Miguel; Kritski, Afrânio Lineu(1) Background: The Commercial Kit SIRE Nitratase® PlastLabor, is a drug susceptibility test kit used to detect Mycobacterium tuberculosis resistance to first-line TB treatment drugs. The present study aimed at evaluating its performance in a multicenter study. (2) Methods: To determine its accuracy, the proportion methods in Lowenstein Jensen medium or the BACTECTMMGITTM960 system was used as a gold standard. (3) Results: The study revealed that the respective accuracies of the kit with 190 M. tuberculosis clinical isolates, using the proportion methods in Lowenstein Jensen medium or BACTECTMMGITTM960 system as a gold standard, were 93.9% and 94.6%, 96.9% and 94.6%, 98.0% and 97.8%, and 98.0% and 98.9%, for streptomycin, isoniazid, rifampicin, and ethambutol, respectively. (4) Conclusion: Thus, the kit can rapidly screen resistance to streptomycin, isoniazid, rifampicin, and ethambutol. Additionally, it does not require sophisticated equipment; hence, it can be easily used in the laboratories of low and middle income countries.