Abstract
ObjectiveWe estimated the incremental cost and impact on diagnosis and treatment uptake of national rollout of Xpert MTB/RIF technology (Xpert) for the diagnosis of pulmonary TB above the cost of current guidelines for the years 2011 to 2016 in South Africa.MethodsWe parameterised a population-level decision model with data from national-level TB databases (n = 199,511) and implementation studies. The model follows cohorts of TB suspects from diagnosis to treatment under current diagnostic guidelines or an algorithm that includes Xpert. Assumptions include the number of TB suspects, symptom prevalence of 5.5%, annual suspect growth rate of 10%, and 2010 public-sector salaries and drug and service delivery costs. Xpert test costs are based on data from an in-country pilot evaluation and assumptions about when global volumes allowing cartridge discounts will be reached.ResultsAt full scale, Xpert will increase the number of TB cases diagnosed per year by 30%–37% and the number of MDR-TB cases diagnosed by 69%–71%. It will diagnose 81% of patients after the first visit, compared to 46% currently. The cost of TB diagnosis per suspect will increase by 55% to USD 60–61 and the cost of diagnosis and treatment per TB case treated by 8% to USD 797–873. The incremental capital cost of the Xpert scale-up will be USD 22 million and the incremental recurrent cost USD 287–316 million over six years.ConclusionXpert will increase both the number of TB cases diagnosed and treated and the cost of TB diagnosis. These results do not include savings due to reduced transmission of TB as a result of earlier diagnosis and treatment initiation.
Highlights
South Africa bears a large share of the global burden of HIV and tuberculosis (TB) co-infection, with a TB prevalence of 795/ 100,000 in 2010 [1]
Sources of Data For this study we developed a model representing the diagnostic process starting with TB suspects, continuing to TB cases, and ending with treatment
Data for the model came from a random sample of all patients entered into the national-level National Health Laboratory Service (NHLS) TB specimen database in 2010 (n = 1,329,664) and a random sample of all patients entered into the national-level Electronic TB Register in 2010 (ETR, n = 286,741)
Summary
South Africa bears a large share of the global burden of HIV and tuberculosis (TB) co-infection, with a TB prevalence of 795/ 100,000 in 2010 [1]. South Africa has a high burden of multi-drug resistant TB (MDR-TB), with more than 7,000 cases diagnosed in 2010 [1]. In this context, conventional TB diagnostic technologies that have been used for decades, such as smear microscopy, are no longer reliable, because 24% to 61% of HIV-positive tuberculosis patients are smear-negative [3]. Significant hope for turning the tide of the TB epidemic lies with the recent development of rapid molecular assays. Once a sputum sample has been collected from a patient, results are available in about 2 hours, without the requirement of highly trained laboratory personnel or additional biosafety measures [4]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
