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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: A cost-effectiveness analysis
PLoS Medicine, Volume 8, No. 11, Article e1001120, Year 2011
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Description
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. © 2011 Vassall et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3210757/bin/pmed.1001120.s001.doc
Authors & Co-Authors
Vassall, Anna
Unknown Affiliation
van Kampen, Sanne Christine
Unknown Affiliation
Sohn, Hojoon
Unknown Affiliation
Michael, Joy Sarojini
Unknown Affiliation
John, K. R.
Unknown Affiliation
den Boon, Saskia
Unknown Affiliation
Davis, J. Lucian
Unknown Affiliation
Whitelaw, Andrew C.
Unknown Affiliation
Nicol, Mark P.
Unknown Affiliation
Gler, Maria Tarcela S.
Unknown Affiliation
Khaliqov, Anar
Unknown Affiliation
Zamudio, Carlos Caicedo
Unknown Affiliation
Perkins, Mark D.
Unknown Affiliation
Boehme, Catharina C.
Unknown Affiliation
Cobelens, Frank G.J.
Unknown Affiliation
Statistics
Citations: 315
Authors: 15
Affiliations: 14
Identifiers
Doi:
10.1371/journal.pmed.1001120
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Disability
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
South Africa
Uganda