Microscopic observation drug‐susceptibility assay vs. Xpert® MTB/RIF for the diagnosis of tuberculosis in a rural African setting: a cost–utility analysis. Issue 6 (2nd May 2017)

• Record Type: Journal Article
• Authors: Wikman‐Jorgensen, Philip E.; Llenas‐García, Jara; Pérez‐Porcuna, Tomàs M.; Hobbins, Michael; Ehmer, Jochen; Mussa, Manuel A.; Ascaso, Carlos
• Is Part Of: Tropical medicine & international health. Volume 22:Issue 6(2017)
• Page Start: 734
• Page End: 743
• Publication Date: 2017-05-02
• Subjects: Mycobacterium tuberculosis -- diagnosis -- cost‐effectiveness analysis -- Sub‐Saharan Africa; Mycobacterium tuberculosis -- diagnostic -- analyse coût‐efficacité -- Afrique subsaharienne; Mycobacterium tuberculosis -- Diagnóstico -- análisis de Coste‐Efectividad -- África subsahariana; Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12879
• Languages: English
• ISSNs: 1360-2276

Abstract

Abstract: Objective: To compare the cost–utility of microscopic observation drug‐susceptibility assay (MODS) and Xpert ® MTB/RIF implementation for tuberculosis (TB) diagnosis in rural northern Mozambique. Methods: Stochastic transmission compartmental TB model from the healthcare provider perspective with parameter input from direct measurements, systematic literature reviews and expert opinion. MODS and Xpert ® MTB/RIF were evaluated as replacement test of smear microscopy (SM) or as an add‐on test after a negative SM. Costs were calculated in 2013 USD, effects in disability‐adjusted life years (DALY). Willingness to pay threshold (WPT) was established at once the per capita Gross National Income of Mozambique. Results: MODS as an add‐on test to negative SM produced an incremental cost‐effectiveness ratio (ICER) of 5647.89USD/DALY averted. MODS as a substitute for SM yielded an ICER of 5374.58USD/DALY averted. Xpert ® MTB/RIF as an add‐on test to negative SM yielded ICER of 345.71USD/DALY averted. Xpert ® MTB/RIF as a substitute for SM obtained an ICER of 122.13USD/DALY averted. TB prevalence and risk of infection were the main factors impacting MODS and Xpert ® MTB/RIF ICER in the one‐way sensitivity analysis. In the probabilistic sensitivity analysis, Xpert ® MTB/RIF was most likely to have an ICER below the WPT, whereas MODS was not. Conclusion: Our cost–utility analysis favours the implementation of Xpert ® MTB/RIF as a replacement of SM for all TB suspects in this rural high TB/HIV prevalence African setting.