![]() ![]() Depending whether CXR was performed on all suspects or on smear-negative suspects only, 22%–45% of patients labeled as "TB" had a negative culture. The low specificity of chest X-ray remains a subject of concern. When cost of treatment was also considered CXR followed by ZN became more cost-effective. The diagnostic pathway ZN followed by CXR was more cost-effective as compared to CXR followed by ZN. When costs of treatment were included, CXR followed by ZN became more cost-effective. The cost per correctly diagnosed case was for the routine process $8.72, compared to $9.27 using CXR as screening tool. Using chest CXR as a screening tool in all suspects, sensitivity/specificity of the score " any pathology" was 92%, respectively 63%. The sensitivity/specificity of the CXR score "TB" among smear-negative suspects was 80%/67%. 714 films were re-read, showing a 89% agreement (kappa value = 0.75 s.e.0.037) for the combined scores " TB" or " no-TB". Of the 1,389 suspects enrolled, for 998 (72%) data on smear, culture and CXR was complete. Laboratory and CXR costs were used to compare for cost-effectiveness. HIV test was performed on those who consented. Films were re-read by a reference radiologist. The combined score i + ii was labeled as " no TB" and the combined score iii + iv was labeled as " TB". From each suspect a CXR was made using a four point scoring system: i: no pathology, ii: pathology not consistent for TB, iii: pathology consistent for TB and iv: pathology highly consistent for TB. Methodsįrom TB suspects attending a chest clinic in Nairobi, Kenya, three sputum specimens were examined for ZN and culture (Lowenstein Jensen). The objective of this study was to establish 1) the performance of chest X-ray (CXR) in all suspects of tuberculosis (TB), as well as smear-negative TB suspects and 2) to compare the cost-effectiveness of the routine diagnostic pathway using Ziehl-Neelsen (ZN) sputum microscopy followed by CXR if case of negative sputum result (ZN followed by CXR) with an alternative pathway using CXR as a screening tool (CXR followed by ZN). ![]()
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