Cost-effectiveness analysis of the Xpert MTB/RIF assay for rapid diagnosis of suspected tuberculosis in an intermediate burden area. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: You, Joyce H.S.; Lui, Grace; Kam, Kai Man; Lee, Nelson L.S.
• Is Part Of: Journal of infection. Volume 70:Issue 4(2015)
• Page Start: 409
• Page End: 414
• Publication Date: 2015-04
• Subjects: Rapid testing -- Tuberculosis -- Decision-analytic model -- Cost-effectiveness -- Hong Kong; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2014.12.015
• Languages: English
• ISSNs: 0163-4453

Abstract

Summary: Objectives: We examined, from a Hong Kong healthcare providers' perspective, the cost-effectiveness of rapid diagnosis with Xpert in patients hospitalized for suspected active pulmonary tuberculosis (PTB). Methods: A decision tree was designed to simulate outcomes of three diagnostic assessment strategies in adult patients hospitalized for suspected active PTB: conventional approach, sputum smear plus Xpert for acid-fast bacilli (AFB) smear-negative, and a single sputum Xpert test. Model inputs were derived from the literature. Outcome measures were direct medical cost, one-year mortality rate, quality-adjusted life-years (QALYs) and incremental cost per QALY (ICER). Results: In the base-case analysis, Xpert was more effective with higher QALYs gained and a lower mortality rate when compared with smear plus Xpert by an ICER of USD99. A conventional diagnostic approach was the least preferred option with the highest cost, lowest QALYs gained and highest mortality rate. Sensitivity analysis showed that Xpert would be the most cost-effective option if the sensitivity of sputum AFB smear microscopy was ≤74%. The probabilities of Xpert, smear plus Xpert and a conventional approach to be cost-effective were 94.5%, 5.5% and 0%, respectively, in 10, 000 Monte Carlo simulations. Conclusions: The Xpert sputum test appears to be a highly cost-effective diagnostic strategy for patients with suspected active PTB in an intermediate burden area like Hong Kong. Highlights: Cost-effectiveness of Xpert MTB/RIF for tuberculosis in intermediate burden area. Xpert was more cost-effective than smear plus Xpert by an ICER of USD99. Xpert was cost-effective in 94.5% of 10, 000 Monte-Carlo simulations. Xpert appears to be highly cost-effective for diagnosis of suspected tuberculosis.