{"doi":"10.1093/cid/ciaa1698","title":"Cost-effectiveness of a Novel Lipoarabinomannan Test for Tuberculosis in Patients With Human Immunodeficiency Virus","abstract":"BACKGROUND: A novel urine lipoarabinomannan assay (FujiLAM) has higher sensitivity and higher cost than the first-generation AlereLAM assay. We evaluated the cost-effectiveness of FujiLAM for tuberculosis testing among hospitalized people with human immunodeficiency virus (HIV), irrespective of symptoms. METHODS: We used a microsimulation model to project clinical and economic outcomes of 3 testing strategies: (1) sputum Xpert MTB/RIF (Xpert), (2) sputum Xpert plus urine AlereLAM (Xpert+AlereLAM), (3) sputum Xpert plus urine FujiLAM (Xpert+FujiLAM). The modeled cohort matched that of a 2-country clinical trial. We applied diagnostic yields from a retrospective study (yields for Xpert/Xpert+AlereLAM/Xpert+FujiLAM among those with CD4 <200 cells/µL: 33%/62%/70%; among those with CD4 ≥200 cells/µL: 33%/35%/47%). Costs of Xpert/AlereLAM/FujiLAM were US$15/3/6 (South Africa) and $25/3/6 (Malawi). Xpert+FujiLAM was considered cost-effective if its incremental cost-effectiveness ratio (US$/year-of-life saved) was <$940 (South Africa) and <$750 (Malawi). We varied key parameters in sensitivity analysis and performed a budget impact analysis of implementing FujiLAM countrywide. RESULTS: Compared with Xpert+AlereLAM, Xpert+FujiLAM increased life expectancy by 0.2 years for those tested in South Africa and Malawi. Xpert+FujiLAM was cost-effective in both countries. Xpert+FujiLAM for all patients remained cost-effective compared with sequential testing and CD4-stratified testing strategies. FujiLAM use added 3.5% (South Africa) and 4.7% (Malawi) to 5-year healthcare costs of tested patients, primarily reflecting ongoing HIV treatment costs among survivors. CONCLUSIONS: FujiLAM with Xpert for tuberculosis testing in hospitalized people with HIV is likely to increase life expectancy and be cost-effective at the currently anticipated price in South Africa and Malawi. Additional studies should evaluate FujiLAM in clinical practice settings.","journal":"Clinical Infectious Diseases","year":2020,"id":77616,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":19,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9461,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":287968,"name":"Claudia M. Denkinger","orcid":"0000-0002-7216-7067","position":1,"is_corresponding":false},{"id":287955,"name":"Tobias Broger","orcid":"0000-0002-7959-1055","position":2,"is_corresponding":false},{"id":404349,"name":"Nicole C. McCann","orcid":"0000-0002-4916-4319","position":3,"is_corresponding":false},{"id":404350,"name":"Ankur Gupta‐Wright","orcid":"0000-0002-5150-2970","position":4,"is_corresponding":false},{"id":292861,"name":"Andrew D. Kerkhoff","orcid":"0000-0002-5023-6658","position":5,"is_corresponding":false},{"id":404351,"name":"Pamela P. Pei","orcid":"0000-0002-6095-8494","position":6,"is_corresponding":false},{"id":273586,"name":"Fatma M. Shebl","orcid":"0000-0002-9750-0049","position":7,"is_corresponding":false},{"id":231904,"name":"Katherine Fielding","orcid":"0000-0002-6524-3754","position":8,"is_corresponding":false},{"id":242133,"name":"Mark P. Nicol","orcid":"0000-0002-1366-4805","position":9,"is_corresponding":false},{"id":231885,"name":"C. Robert Horsburgh","orcid":"0000-0001-6838-7895","position":10,"is_corresponding":false},{"id":292884,"name":"Graeme Meintjes","orcid":"0000-0003-1196-4414","position":11,"is_corresponding":false},{"id":404352,"name":"Kenneth A. Freedberg","orcid":"0000-0003-3143-7822","position":12,"is_corresponding":false},{"id":252299,"name":"Robin Wood","orcid":"0000-0002-4276-7117","position":13,"is_corresponding":false},{"id":226457,"name":"Rochelle P. Walensky","orcid":"0000-0002-8795-379X","position":14,"is_corresponding":false},{"id":273585,"name":"Krishna P. Reddy","orcid":"0000-0002-1832-2193","position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":null,"created_at":"2026-07-18T21:49:16.197289Z","pmid":"33200169","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}