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

Anna Vassall; Sanne van Kampen; Hojoon Sohn; Joy S. Michael; K. R. John; Saskia den Boon; J. Lucian Davis; Andrew Whitelaw; Mark P. Nicol; Maria Tarcela Gler; Anar Khaliqov; Carlos Zamudio; Mark D. Perkins; Catharina C. Boehme; Frank Cobelens

doi:https://doi.org/10.1371/journal.pmed.1001120

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

Anna Vassall, Sanne van Kampen, Hojoon Sohn, Joy S. Michael, K. R. John, Saskia den Boon, J. Lucian Davis, Andrew Whitelaw, Mark P. Nicol, Maria Tarcela Gler, Anar Khaliqov, Carlos Zamudio, Mark D. Perkins, Catharina C. Boehme, Frank Cobelens

Research output: Contribution to journal › Article › Academic › peer-review

255 Citations (Scopus)

Abstract

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. 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. 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

Original language	English
Pages (from-to)	e1001120
Journal	PLoS medicine
Volume	8
Issue number	11
DOIs	https://doi.org/10.1371/journal.pmed.1001120
Publication status	Published - 2011

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https://doi.org/10.1371/journal.pmed.1001120

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Vassall, A., van Kampen, S., Sohn, H., Michael, J. S., John, K. R., den Boon, S., Davis, J. L., Whitelaw, A., Nicol, M. P., Gler, M. T., Khaliqov, A., Zamudio, C., Perkins, M. D., Boehme, C. C., & Cobelens, F. (2011). Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. PLoS medicine, 8(11), e1001120. https://doi.org/10.1371/journal.pmed.1001120

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

abstract = "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. 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. 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",

author = "Anna Vassall and {van Kampen}, Sanne and Hojoon Sohn and Michael, {Joy S.} and John, {K. R.} and {den Boon}, Saskia and Davis, {J. Lucian} and Andrew Whitelaw and Nicol, {Mark P.} and Gler, {Maria Tarcela} and Anar Khaliqov and Carlos Zamudio and Perkins, {Mark D.} and Boehme, {Catharina C.} and Frank Cobelens",

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Vassall, A, van Kampen, S, Sohn, H, Michael, JS, John, KR, den Boon, S, Davis, JL, Whitelaw, A, Nicol, MP, Gler, MT, Khaliqov, A, Zamudio, C, Perkins, MD, Boehme, CC & Cobelens, F 2011, 'Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis', PLoS medicine, vol. 8, no. 11, pp. e1001120. https://doi.org/10.1371/journal.pmed.1001120

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T1 - Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis

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

PY - 2011

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N2 - 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. 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. 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

AB - 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. 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. 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

U2 - https://doi.org/10.1371/journal.pmed.1001120

DO - https://doi.org/10.1371/journal.pmed.1001120

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