Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis.
<h4>Background</h4>Xpert MTB/RIF (Xpert) is a promising new rapid diagnostic technology for tuberculosis (TB) that has characteristics that suggest large-scale roll-out. However, because the test is expensive, there are concerns among TB program managers and policy makers regarding its a...
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Public Library of Science (PLoS)
2011
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oai:doaj.org-article:b3ef06466a6544ef8fc3efe2db318af22021-12-02T19:55:48ZRapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis.1549-12771549-167610.1371/journal.pmed.1001120https://doaj.org/article/b3ef06466a6544ef8fc3efe2db318af22011-11-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22087078/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Xpert MTB/RIF (Xpert) is a promising new rapid diagnostic technology for tuberculosis (TB) that has characteristics that suggest large-scale roll-out. However, because the test is expensive, there are concerns among TB program managers and policy makers regarding its affordability for low- and middle-income settings.<h4>Methods and findings</h4>We estimate the impact of the introduction of Xpert on the costs and cost-effectiveness of TB care using decision analytic modelling, comparing the introduction of Xpert to a base case of smear microscopy and clinical diagnosis in India, South Africa, and Uganda. The introduction of Xpert increases TB case finding in all three settings; from 72%-85% to 95%-99% of the cohort of individuals with suspected TB, compared to the base case. Diagnostic costs (including the costs of testing all individuals with suspected TB) also increase: from US$28-US$49 to US$133-US$146 and US$137-US$151 per TB case detected when Xpert is used "in addition to" and "as a replacement of" smear microscopy, respectively. The incremental cost effectiveness ratios (ICERs) for using Xpert "in addition to" smear microscopy, compared to the base case, range from US$41-$110 per disability adjusted life year (DALY) averted. Likewise the ICERS for using Xpert "as a replacement of" smear microscopy range from US$52-$138 per DALY averted. These ICERs are below the World Health Organization (WHO) willingness to pay threshold.<h4>Conclusions</h4>Our results suggest that Xpert is a cost-effective method of TB diagnosis, compared to a base case of smear microscopy and clinical diagnosis of smear-negative TB in low- and middle-income settings where, with its ability to substantially increase case finding, it has important potential for improving TB diagnosis and control. The extent of cost-effectiveness gain to TB programmes from deploying Xpert is primarily dependent on current TB diagnostic practices. Further work is required during scale-up to validate these findings.Anna VassallSanne van KampenHojoon SohnJoy S MichaelK R JohnSaskia den BoonJ Lucian DavisAndrew WhitelawMark P NicolMaria Tarcela GlerAnar KhaliqovCarlos ZamudioMark D PerkinsCatharina C BoehmeFrank CobelensPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 8, Iss 11, p e1001120 (2011) |
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Medicine R |
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Medicine R Anna Vassall Sanne van Kampen Hojoon Sohn Joy S Michael K R John Saskia den Boon J Lucian Davis Andrew Whitelaw Mark P Nicol Maria Tarcela Gler Anar Khaliqov Carlos Zamudio Mark D Perkins Catharina C Boehme Frank Cobelens Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. |
| description |
<h4>Background</h4>Xpert MTB/RIF (Xpert) is a promising new rapid diagnostic technology for tuberculosis (TB) that has characteristics that suggest large-scale roll-out. However, because the test is expensive, there are concerns among TB program managers and policy makers regarding its affordability for low- and middle-income settings.<h4>Methods and findings</h4>We estimate the impact of the introduction of Xpert on the costs and cost-effectiveness of TB care using decision analytic modelling, comparing the introduction of Xpert to a base case of smear microscopy and clinical diagnosis in India, South Africa, and Uganda. The introduction of Xpert increases TB case finding in all three settings; from 72%-85% to 95%-99% of the cohort of individuals with suspected TB, compared to the base case. Diagnostic costs (including the costs of testing all individuals with suspected TB) also increase: from US$28-US$49 to US$133-US$146 and US$137-US$151 per TB case detected when Xpert is used "in addition to" and "as a replacement of" smear microscopy, respectively. The incremental cost effectiveness ratios (ICERs) for using Xpert "in addition to" smear microscopy, compared to the base case, range from US$41-$110 per disability adjusted life year (DALY) averted. Likewise the ICERS for using Xpert "as a replacement of" smear microscopy range from US$52-$138 per DALY averted. These ICERs are below the World Health Organization (WHO) willingness to pay threshold.<h4>Conclusions</h4>Our results suggest that Xpert is a cost-effective method of TB diagnosis, compared to a base case of smear microscopy and clinical diagnosis of smear-negative TB in low- and middle-income settings where, with its ability to substantially increase case finding, it has important potential for improving TB diagnosis and control. The extent of cost-effectiveness gain to TB programmes from deploying Xpert is primarily dependent on current TB diagnostic practices. Further work is required during scale-up to validate these findings. |
| format |
article |
| author |
Anna Vassall Sanne van Kampen Hojoon Sohn Joy S Michael K R John Saskia den Boon J Lucian Davis Andrew Whitelaw Mark P Nicol Maria Tarcela Gler Anar Khaliqov Carlos Zamudio Mark D Perkins Catharina C Boehme Frank Cobelens |
| author_facet |
Anna Vassall Sanne van Kampen Hojoon Sohn Joy S Michael K R John Saskia den Boon J Lucian Davis Andrew Whitelaw Mark P Nicol Maria Tarcela Gler Anar Khaliqov Carlos Zamudio Mark D Perkins Catharina C Boehme Frank Cobelens |
| author_sort |
Anna Vassall |
| title |
Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. |
| title_short |
Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. |
| title_full |
Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. |
| title_fullStr |
Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. |
| title_full_unstemmed |
Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. |
| title_sort |
rapid diagnosis of tuberculosis with the xpert mtb/rif assay in high burden countries: a cost-effectiveness analysis. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2011 |
| url |
https://doaj.org/article/b3ef06466a6544ef8fc3efe2db318af2 |
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| _version_ |
1718375860693630976 |