Cost Evaluation of Current Pulmonary MTB Diagnosis Process in a Hospital in Abu Dhabi and Proposal to Implement the World Health Organization MTB Clinical Pathway

• Published in: Eurasian Journal of Emergency Medicine
• Main Authors: Ward Ghaleb, Yamama Aljishi, Sanjay Ayathan, Ayesha Almemari
• Format: Article
• Language: English
• Published: Emergency Medicine Physicians’ Association of Turkey 2023-06-01
• Subjects: pulmonary mtb; emergency department; cost evaluation; mycobacterium tuberculosis; who clinical pathway; x-pert mtb/rif; afb smear
• Online Access: http://eajem.com/archives/archive-detail/article-preview/cost-evaluation-of-current-pulmonary-mtb-diagnosis/60681

Aim:Mycobacterium tuberculosis (MTB) is a leading cause of death worldwide. The World Health Organization (WHO) recommends X-pert MTB/RIF or X-pert Ultra as the initial test for pulmonary MTB diagnosis. While several studies have explored the cost-effectiveness of this technology, none have specifically looked at its use in the United Arab Emirates (UAE). To evaluate the average estimated cost and length of stay for suspected MTB patients admitted from the emergency department to the respiratory isolation rooms to rule out MTB using the MTB classic diagnosis pathway of 3 AFB smear and MTB cultures compared to the estimated cost if the WHO X-pert MTB/RIF outpatient pathway is implemented for suspected MTB.Materials and Methods:A quality improvement project was conducted with a retrospective audit and data analysis of suspected pulmonary MTB infection at a secondary care hospital in Abu Dhabi, UAE. We report the true accrued costs of the current admission practice for management of suspected pulmonary MTB. We also report the estimated cost of working up these same patients with the WHO pathway using X-pert MTB/RIF testing.Results:Data analysis demonstrated that 62% of the cost of working up suspected pulmonary MTB was accumulated during admissions for patients who ultimately proved to be MTB negative. Cost evaluation of study data suggests that using the WHO X-pert MTB/RIF clinical pathway would cost approximately one-tenth as much as the current practice.Conclusion:This analysis presents evidence for cost savings associated with the use of the WHO X-pert MTB/RIF clinical pathway in a low MTB incidence area such as the UAE. Further analysis to assess how the pulmonary MTB diagnostic pathway was influenced by COVID-19 is needed.