PMC:3156114 / 6647-10412 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/3156114","sourcedb":"PMC","sourceid":"3156114","source_url":"https://www.ncbi.nlm.nih.gov/pmc/3156114","text":"Test qualities and diagnostic costs\nEstimates of sensitivity and specificity of diagnostic procedures used in the model are shown in Table 1 and are based on reports from the literature (chest x-ray alone, oral wash with DQ, PCR, nested PCR, and rtPCR; expectorated sputum with GMS, TBO, CW; induced sputum with DQ, GMS, TBO, IS, IFA, PCR, nPCR; BAL with DQ, GMS, TBO, CW, IFA, PCR, nPCR, rtPCR) [29], [30], [31], [36], [38], [39], [40], [44], [47], [48], [49], [50], [52], [54], [55], [57], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], or estimated by the authors (oral wash with IFA, GMS, CW, TBO; expectorated sputum with DQ, IFA, PCR, nPCR, or rtPCR; induced sputum with rtPCR). Although all of the above-referenced literature was consulted, for diagnostic procedures involving any form of PCR, only studies which targeted the mitochondrial large subunit ribosomal RNA were used for estimations of sensitivity and specificity [28], [29], [36], [48], [51], [54], [55], [57], [63], [64], [67], [68], [69], [71], [72], [75], [76], [78], [85], [86]. For tests for which data did not exist in the literature, estimations of test characteristics were based on interpolation and pre-existing knowledge of the sensitivity and specificity of other tests in the same diagnostic category (e.g., we assumed that expectorated sputum with DQ, for which we did not find published reports, would be intermediate in sensitivity between oral wash with DQ and induced sputum with DQ, for which we were able to reference published reports.)\nTable 1 Model inputs and costs: Sensitivity and specificity of diagnostic procedures, based on estimates derived from existing studies (see text) or, when reference studies not available, from author estimation.\nDiagnostic Specimen collection Sensitivity Specificity Cost (USD)\nCXR None 0.86 0.40 $40.00\nDQ Oral wash 0.30 1.00 $2.32\nExpectorated sputum 0.60 1.00 $2.22\nInduced sputum 0.75 1.00 $8.72\nBronchoalveolar lavage 0.75 1.00 $77.12\nGMS Oral wash 0.30 1.00 $4.21\nExpectorated sputum 0.52 0.95 $4.11\nInduced sputum 0.70 0.96 $10.61\nBronchoalveolar lavage 0.82 0.98 $79.01\nTBO Oral wash 0.30 1.00 $0.93\nExpectorated sputum 0.71 1.00 $0.83\nInduced sputum 0.75 1.00 $7.33\nBronchoalveolar lavage 0.80 1.00 $75.73\nCW Oral wash 0.30 1.00 $2.94\nExpectorated sputum 0.33 1.00 $2.84\nInduced sputum 0.57 1.00 $9.34\nBronchoalveolar lavage 0.78 1.00 $77.74\nIFA Oral wash 0.30 1.00 $20.79\nExpectorated sputum 0.50 1.00 $20.69\nInduced sputum 0.81 1.00 $27.19\nBronchoalveolar lavage 1.00 1.00 $95.59\nPCR Oral wash 0.71 0.99 $8.78\nExpectorated sputum 0.85 0.99 $8.68\nInduced sputum 0.94 0.99 $15.18\nBronchoalveolar lavage 1.00 0.94 $83.58\nnPCR Oral wash 0.83 1.00 $10.32\nExpectorated sputum 0.91 1.00 $10.22\nInduced sputum 1.00 1.00 $16.72\nBronchoalveolar lavage 1.00 0.89 $85.12\nrtPCR Oral wash 0.89 0.94 $13.84\nExpectorated sputum 0.92 0.94 $13.74\nInduced sputum 0.95 0.90 $20.24\nBronchoalveolar lavage 0.99 0.80 $88.64\nCXR: Chest x-ray; DQ: Diff-Quick; GMS: Grocott's Methenamine Silver Stain; TBO: Toluidine Blue O; CW: Calcofluor white stain; IFA: Immunofluorescence; PCR: Polymerase chain reaction; nPCR: nested PCR; rtPCR: real-time (quantitative) PCR. Estimates of costs include required materials and personnel time (Tables S1 and S2). Total costs for diagnostic procedures are included in Table 1. Estimated salaries for laboratory and health care workers are available in Appendix S1. Except where stated, all cost and time estimates were provided by the National Institute of Communicable Diseases in South 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