Clinical Report: Adding CRP to CAD-guided TB screening offers no benefit

Overview

A study comparing CAD-guided chest x-ray screening with and without CRP testing found that the CAD-only strategy detected more tuberculosis cases at a lower cost. The CAD-plus-CRP strategy did not demonstrate noninferiority and was 37% more expensive per case detected.

Background

Tuberculosis (TB) remains a significant global health challenge, particularly in resource-limited settings. Effective screening strategies are essential for early detection and treatment to reduce TB transmission. This study evaluates the cost-effectiveness and diagnostic performance of adding C-reactive protein (CRP) testing to a CAD-guided screening approach.

Data Highlights

Key Findings

• The CAD-only strategy identified 94.5% of TB cases compared to 82.2% for CAD plus CRP.
• The CAD-plus-CRP strategy was 37% more expensive per TB case detected.
• Thirteen TB cases were identified exclusively by CAD alone, compared to four by CAD plus CRP.
• 46% of participants with confirmed TB had none of the four main TB symptoms.
• Noninferiority of the CAD-plus-CRP strategy was not demonstrated, as the lower bound of the 95% CI extended below the -10% margin.

Clinical Implications

The findings indicate that adding CRP testing to CAD-guided TB screening does not improve case detection and increases costs.

Conclusion

The study indicates that the CAD-plus-CRP strategy did not demonstrate noninferiority compared to CAD alone.

Related Resources & Content

1. The Lancet Infectious Diseases, 2024 -- Community-based tuberculosis screening with computer-aided detection technology alone and in combination with point-of-care C-reactive protein testing: a paired screen-positive trial
2. Frontiers in Digital Health — Beyond accuracy: evaluating the operational feasibility and diagnostic yield of CAD4TB vs. Timika score for scalable TB screening in low-resource settings
3. Is MRI Essential for All Patients Without Prior Biopsy? Insights from a Multicenter Cohort Study
4. The ASCO Post — Addition of Ultrasound to DBT for Breast Cancer Screening in Patients With Dense Breasts
5. the pathologist — Tuberculosis Screening Accuracy Boosted
6. Executive summary - WHO consolidated guidelines on tuberculosis
7. Recommendations - WHO consolidated guidelines on tuberculosis
8. Community-based tuberculosis screening with computer-aided detection technology alone and in combination with point-of-care C-reactive protein testing: a paired screen-positive trial - ScienceDirect