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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The cost-effectiveness of routine tuberculosis screening with Xpert MTB/RIF prior to initiation of antiretroviral therapy: A model-based analysis
AIDS, Volume 26, No. 8, Year 2012
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Description
Background: In settings with high tuberculosis (TB) prevalence, 15-30% of HIV-infected individuals initiating antiretroviral therapy (ART) have undiagnosed TB. Such patients are usually screened by symptoms and sputum smear, which have poor sensitivity. Objective: To project the clinical and economic outcomes of using Xpert MTB/RIF(Xpert), a rapid TB/rifampicin-resistance diagnostic, to screen individuals initiating ART. Desing: We used a microsimulation model to evaluate the clinical impact and cost-effectiveness of alternative TB screening modalities - in all patients or only symptomatic patients - for hypothetical cohorts of individuals initiating ART in South Africa (mean CD4 cell count = 171 cells/μl; TB prevalence 22%). We simulated no active screening and four diagnostic strategies, smear microscopy (sensitivity 23%); smear and culture (sensitivity, 100%); one Xpert sample (sensitivity in smear-negative TB: 43%); two Xpert samples (sensitivity in smear-negative TB: 62%). Outcomes included projected life expectancy, lifetime costs (2010 US$), and incremental cost-effectiveness ratios (ICERs). Strategies with ICERs less than $7100 (South African gross domestic product per capita) were considered very cost-effective. Results: Compared with no screening, life expectancy in TB-infected patients increased by 1.6 months using smear in symptomatic patients and by 6.6 months with two Xpert samples in all patients. At 22% TB prevalence, the ICER of smear for all patients was $2800 per year of life saved (YLS), and of Xpert (two samples) for all patients was $5100/YLS. Strategies involving one Xpert sample or symptom screening were less efficient. Conclusion: Model-based analysis suggests that screening all individuals initiating ART in South Africa with two Xpert samples is very cost-effective. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Andrews, Jason Randolph
Unknown Affiliation
Lawn, Stephen D.
Unknown Affiliation
Rusu, Corina
Unknown Affiliation
Wood, Robin Y.
Unknown Affiliation
Noubary, Farzad
Unknown Affiliation
Bender, Melissa A.
Unknown Affiliation
Horsburgh, Charles Robert
Unknown Affiliation
Losina, Elena
Unknown Affiliation
Freedberg, Kenneth A.
Unknown Affiliation
Walensky, Rochelle P.
Unknown Affiliation
Statistics
Citations: 83
Authors: 10
Affiliations: 11
Identifiers
Doi:
10.1097/QAD.0b013e3283522d47
e-ISSN:
14735571
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
South Africa