Abstract
BackgroundEarly and accurate diagnosis of tuberculosis is a priority for TB programs globally to initiate treatment early and improve treatment outcomes. Currently, Ziehl–Neelsen (ZN) stain-based microscopy, GeneXpert and Light Emitting Diode-Fluorescence Microscopy (LED-FM) are used for diagnosing pulmonary drug sensitive tuberculosis. Published evidence synthesising the cost-effectiveness of these diagnostic tools is scarce.MethodologyPubMed, EMBASE and Cost-effectiveness analysis registry were searched for studies that reported on the cost-effectiveness of GeneXpert and LED-FM, compared to ZN microscopy for diagnosing pulmonary TB. Risk of bias was assessed independently by four authors using the Consensus Health Economic Criteria (CHEC) extended checklist. The data variables included the study settings, population, type of intervention, type of comparator, year of study, duration of study, type of study design, costs for the test and the comparator and effectiveness indicators. Incremental cost-effectiveness ratio (ICER) was used for assessing the relative cost-effectiveness in this review.ResultsOf the 496 studies identified by the search, thirteen studies were included after removing duplicates and studies that did not fulfil inclusion criteria. Four studies compared LED-FM with ZN and nine studies compared GeneXpert with ZN. Three studies used patient cohorts and eight were modelling studies with hypothetical cohorts used to evaluate cost-effectiveness. All these studies were conducted from a health system perspective, with four studies utilising cost utility analysis. There were considerable variations in costing parameters and effectiveness indicators that precluded meta-analysis. The key findings from the included studies suggest that LED-FM and GeneXpert may be cost effective for pulmonary TB diagnosis from a health system perspective.ConclusionOur review identifies a consistent trend of the cost effectiveness of LED-FM and GeneXpert for pulmonary TB diagnosis in different countries with diverse context of socio-economic condition, HIV burden and geographical distribution. However, all the studies used different parameters to estimate the impact of these tools and this underscores the need for improving the methodological issues related to the conduct and reporting of cost-effectiveness studies.
Highlights
Tuberculosis (TB) remains a leading cause of death worldwide
Our review identifies a consistent trend of the cost effectiveness of Light Emitting Diode-Fluorescence Microscopy (LED-FM) and GeneXpert for pulmonary TB diagnosis in different countries with diverse context of socio-economic condition, Human Immunodeficiency Virus (HIV) burden and geographical distribution
The search yielded 497 studies that had reportedly assessed the cost-effectiveness of GeneXpert and LED-FM
Summary
Tuberculosis (TB) remains a leading cause of death worldwide. Globally, 10.4 million new cases were reported by WHO in 2016 [1]. Though TB treatment averted 49 million deaths globally between 2000 and 2015, diagnostic gaps persist [1]. Early and accurate diagnosis of TB is the top priority of national TB programs globally. Improved diagnostic tools may facilitate early diagnosis and reduce the direct costs of the diagnostic burden on patients and family [5,6]. Ziehl–Neelsen (ZN) stain-based microscopy, GeneXpert and Light Emitting Diode-Fluorescence Microscopy (LED-FM) are widely used diagnostic tools for drug-sensitive pulmonary tuberculosis by National TB programmes in high burden countries. And accurate diagnosis of tuberculosis is a priority for TB programs globally to initiate treatment early and improve treatment outcomes. Ziehl–Neelsen (ZN) stainbased microscopy, GeneXpert and Light Emitting Diode-Fluorescence Microscopy (LEDFM) are used for diagnosing pulmonary drug sensitive tuberculosis. Published evidence synthesising the cost-effectiveness of these diagnostic tools is scarce
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