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Background: Tuberculosis (TB) remains a significant health problem in the Canadian Arctic. Substantial health system delays in TB diagnosis can occur, in part due to the lack of capacity for onsite microbiologic testing. A study recently evaluated the yield and impact of a rapid automated PCR test (Xpert®MTB/RIF) for the diagnosis of TB in Iqaluit (Nunavut). We conducted an economic analysis to evaluate the expected cost relative to the expected reduction in time to treatment initiation, with the addition of Xpert®MTB/RIF to the current diagnostic and treatment algorithms used in this setting. Methods: A decision analysis model compared current microbiologic testing to a scenario where Xpert®MTB/RIF was added to the current diagnostic algorithm for active TB, and incorporated costs and clinical endpoints from the Iqaluit study. Several sensitivity analyses that considered alternative use were also considered. We estimated days to TB diagnosis and treatment initiation, health system costs, and the incremental cost per treatment day gained for each individual evaluated for possible TB. Results: With the addition of Xpert®MTB/RIF, costs increased while days to TB treatment initiation were reduced. The incremental cost per treatment day gained (per individual investigated for TB) was $164 (95% uncertainty range $85, $452). In a sensitivity analysis that considered hospital discharge after a single negative Xpert®MTB/RIF, the Xpert®MTB/RIF scenario was cost saving. Interpretation: Adding Xpert®MTB/RIF to the current diagnostic algorithm for TB in Nunavut appears to reduce time to diagnosis and treatment at reasonable cost. It may be especially well suited to overcome some of the other logistical barriers that are unique to this and other remote communities. [ABSTRACT FROM AUTHOR]

Objectives. This article describes the review processes required for research being conducted in Canada's 3 northern territories. When conducting research involving human subjects in northern Canada, researchers must go through a 2-step process by submitting protocols to both their university or hospital ethics review boards as well as to northern research institutions. Canada's northern territorial governments have requirements for attaining licensure before any research can be conducted. Methods. A document review was the method used to gather data, and an Internet search of the literature and documents was conducted to gather information. Results. Generally, university and hospital-based ethics review boards have been concerned with the rights of individuals in research. Northern Canadian research protocols require review by territorial government institutions and communities with respect to community rights. Conclusions. The 3 territorial governments of northern Canada take the concept of community and individual participation in research seriously and have enacted processes so that opportunities for such approaches to research are ensured. [ABSTRACT FROM AUTHOR]