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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The impact and cost of scaling up genexpert MTB/RIF in South Africa
PLoS ONE, Volume 7, No. 5, Article e36966, Year 2012
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Description
Objective: We estimated the incremental cost and impact on diagnosis and treatment uptake of national rollout of Xpert MTB/RIF technology (Xpert) for the diagnosis of pulmonary TB above the cost of current guidelines for the years 2011 to 2016 in South Africa. Methods: We parameterised a population-level decision model with data from national-level TB databases (n = 199,511) and implementation studies. The model follows cohorts of TB suspects from diagnosis to treatment under current diagnostic guidelines or an algorithm that includes Xpert. Assumptions include the number of TB suspects, symptom prevalence of 5.5%, annual suspect growth rate of 10%, and 2010 public-sector salaries and drug and service delivery costs. Xpert test costs are based on data from an in-country pilot evaluation and assumptions about when global volumes allowing cartridge discounts will be reached. Results: At full scale, Xpert will increase the number of TB cases diagnosed per year by 30%-37% and the number of MDR-TB cases diagnosed by 69%-71%. It will diagnose 81% of patients after the first visit, compared to 46% currently. The cost of TB diagnosis per suspect will increase by 55% to USD 60-61 and the cost of diagnosis and treatment per TB case treated by 8% to USD 797-873. The incremental capital cost of the Xpert scale-up will be USD 22 million and the incremental recurrent cost USD 287-316 million over six years. Conclusion: Xpert will increase both the number of TB cases diagnosed and treated and the cost of TB diagnosis. These results do not include savings due to reduced transmission of TB as a result of earlier diagnosis and treatment initiation. © 2012 Meyer-Rath et al.
Authors & Co-Authors
Meyer-Rath, Gesine
South Africa, Johannesburg
University of the Witwatersrand
United States, Boston
School of Public Health
Schnippel, Kathryn
South Africa, Johannesburg
University of the Witwatersrand
Long, Lawrence C.
South Africa, Johannesburg
University of the Witwatersrand
MacLeod, William Bruce
South Africa, Johannesburg
University of the Witwatersrand
United States, Boston
School of Public Health
Sanne, Ian
South Africa, Johannesburg
University of the Witwatersrand
United States, Boston
School of Public Health
Stevens, Wendy Susan
South Africa, Johannesburg
National Health Laboratory Service
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
South Africa, Johannesburg
University of the Witwatersrand
Pillay, Sagie
South Africa, Johannesburg
National Health Laboratory Service
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Pillay, Yogan G.
South Africa, Pretoria
Department of Health, Pretoria
Rosen, Sydney B.
South Africa, Johannesburg
University of the Witwatersrand
United States, Boston
School of Public Health
Statistics
Citations: 167
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1371/journal.pone.0036966
e-ISSN:
19326203
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
South Africa