Universidad Peruana Cayetano Heredia

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, A.
dc.contributor.author van Kampen, S.
dc.contributor.author Sohn, H.
dc.contributor.author Michael, J.S.
dc.contributor.author John, K.R.
dc.contributor.author den Boon, S.
dc.contributor.author Davis, J.L.
dc.contributor.author Whitelaw, A.
dc.contributor.author Nicol, M.P.
dc.contributor.author Gler, M.T.
dc.contributor.author Khaliqov, A.
dc.contributor.author Zamudio Fuertes, Carlos Eduardo
dc.contributor.author Perkins, M.D.
dc.contributor.author Boehme, C.C.
dc.contributor.author Cobelens, F.
dc.date.accessioned 2022-01-18T19:34:37Z
dc.date.available 2022-01-18T19:34:37Z
dc.date.issued 2011
dc.identifier.uri https://hdl.handle.net/20.500.12866/11061
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_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Humans en_US
dc.subject cohort analysis en_US
dc.subject Cohort Studies en_US
dc.subject controlled study en_US
dc.subject diagnostic test en_US
dc.subject health care policy en_US
dc.subject rifampicin en_US
dc.subject methodology en_US
dc.subject South Africa en_US
dc.subject developing country en_US
dc.subject culture medium en_US
dc.subject bacterium culture en_US
dc.subject economics en_US
dc.subject health care cost en_US
dc.subject lung tuberculosis en_US
dc.subject Tuberculosis, Pulmonary en_US
dc.subject Uganda en_US
dc.subject multidrug resistant tuberculosis en_US
dc.subject thorax radiography en_US
dc.subject cost effectiveness analysis en_US
dc.subject Cost-Benefit Analysis en_US
dc.subject world health organization en_US
dc.subject smear en_US
dc.subject antibiotic sensitivity en_US
dc.subject cost benefit analysis en_US
dc.subject lowest income group en_US
dc.subject India en_US
dc.subject Clinical Laboratory Techniques en_US
dc.subject Human immunodeficiency virus prevalence en_US
dc.subject quality adjusted life year en_US
dc.subject tuberculosis control en_US
dc.subject diagnostic procedures en_US
dc.title Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: A cost-effectiveness analysis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pmed.1001120
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1549-1676


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