Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis

 

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dc.contributor.author Vassall, Anna en_ZA
dc.contributor.author van Kampen, Sanne en_ZA
dc.contributor.author Sohn, Hojoon en_ZA
dc.contributor.author Michael, Joy S en_ZA
dc.contributor.author John, K R en_ZA
dc.contributor.author den Boon, Saskia en_ZA
dc.contributor.author Davis, J Lucian en_ZA
dc.contributor.author Whitelaw, Andrew en_ZA
dc.contributor.author Nicol, Mark P en_ZA
dc.contributor.author Gler, Maria Tarcela en_ZA
dc.contributor.author Khaliqov, Anar en_ZA
dc.contributor.author Zamudio, Carlos en_ZA
dc.contributor.author Perkins, Mark D en_ZA
dc.contributor.author Boehme, Catharina C en_ZA
dc.contributor.author Cobelens, Frank en_ZA
dc.date.accessioned 2016-01-02T05:07:42Z
dc.date.available 2016-01-02T05:07:42Z
dc.date.issued 2011 en_ZA
dc.identifier.citation Vassall, A., van Kampen, S., Sohn, H., Michael, J. S., John, K. R., den Boon, S., ... & Khaliqov, A. (2011). Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. PLoS medicine, 8(11), 1518. doi:10.1371/journal.pmed.1001120 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/16177
dc.identifier.uri http://dx.doi.org/10.1371/journal.pmed.1001120
dc.description.abstract Background: 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. Methods and Findings: 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. Conclusions: 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. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLOS Medicince en_ZA
dc.source.uri http://journals.plos.org/plosmedicine en_ZA
dc.subject.other Tuberculosis en_ZA
dc.subject.other Tuberculosis diagnosis and management en_ZA
dc.subject.other Cost-effectiveness analysis en_ZA
dc.subject.other Sputum en_ZA
dc.subject.other Mycobacterium tuberculosis en_ZA
dc.subject.other HIV diagnosis and management en_ZA
dc.subject.other Diagnostic medicine en_ZA
dc.subject.other Multi-drug-resistant tuberculosis en_ZA
dc.title Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2011 Vassall et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Medical Biochemistry en_ZA
uct.type.filetype Text
uct.type.filetype Image


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.