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

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dc.contributor.authorVassall, Annaen_ZA
dc.contributor.authorvan Kampen, Sanneen_ZA
dc.contributor.authorSohn, Hojoonen_ZA
dc.contributor.authorMichael, Joy Sen_ZA
dc.contributor.authorJohn, K Ren_ZA
dc.contributor.authorden Boon, Saskiaen_ZA
dc.contributor.authorDavis, J Lucianen_ZA
dc.contributor.authorWhitelaw, Andrewen_ZA
dc.contributor.authorNicol, Mark Pen_ZA
dc.contributor.authorGler, Maria Tarcelaen_ZA
dc.contributor.authorKhaliqov, Anaren_ZA
dc.contributor.authorZamudio, Carlosen_ZA
dc.contributor.authorPerkins, Mark Den_ZA
dc.contributor.authorBoehme, Catharina Cen_ZA
dc.contributor.authorCobelens, Franken_ZA
dc.date.accessioned2016-01-02T05:07:42Z
dc.date.available2016-01-02T05:07:42Z
dc.date.issued2011en_ZA
dc.description.abstractBackground: 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.identifier.apacitationVassall, A., van Kampen, S., Sohn, H., Michael, J. S., John, K. R., den Boon, S., ... Cobelens, F. (2011). Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. <i>PLOS Medicince</i>, http://hdl.handle.net/11427/16177en_ZA
dc.identifier.chicagocitationVassall, Anna, Sanne van Kampen, Hojoon Sohn, Joy S Michael, K R John, Saskia den Boon, J Lucian Davis, et al "Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis." <i>PLOS Medicince</i> (2011) http://hdl.handle.net/11427/16177en_ZA
dc.identifier.citationVassall, 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.1001120en_ZA
dc.identifier.ris TY - Journal Article AU - Vassall, Anna AU - van Kampen, Sanne AU - Sohn, Hojoon AU - Michael, Joy S AU - John, K R AU - den Boon, Saskia AU - Davis, J Lucian AU - Whitelaw, Andrew AU - Nicol, Mark P AU - Gler, Maria Tarcela AU - Khaliqov, Anar AU - Zamudio, Carlos AU - Perkins, Mark D AU - Boehme, Catharina C AU - Cobelens, Frank AB - 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. DA - 2011 DB - OpenUCT DO - 10.1371/journal.pmed.1001120 DP - University of Cape Town J1 - PLOS Medicince LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis TI - Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis UR - http://hdl.handle.net/11427/16177 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16177
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pmed.1001120
dc.identifier.vancouvercitationVassall A, van Kampen S, Sohn H, Michael JS, John KR, den Boon S, et al. Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. PLOS Medicince. 2011; http://hdl.handle.net/11427/16177.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Medical Biochemistryen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2011 Vassall et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLOS Medicinceen_ZA
dc.source.urihttp://journals.plos.org/plosmedicineen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherTuberculosis diagnosis and managementen_ZA
dc.subject.otherCost-effectiveness analysisen_ZA
dc.subject.otherSputumen_ZA
dc.subject.otherMycobacterium tuberculosisen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherDiagnostic medicineen_ZA
dc.subject.otherMulti-drug-resistant tuberculosisen_ZA
dc.titleRapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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