Cost-Effectiveness of Tuberculosis Diagnostic Strategies to Reduce Early Mortality Among Persons With Advanced HIV Infection Initiating Antiretroviral Therapy

Abstract

Our analysis showed that culture or Xpert were cost-effective at reducing early mortality during the first 6 months of ART compared with the current practice. Thus, our findings provide support for ongoing efforts to expand TB diagnostic capacity.

Global evidence directing regional preventive strategies in Southeast Asia for fighting TB/HIV

“…A physician's decision, based on a clinical work-up of symptoms, chest X-ray (CXR), and sputum smear microscopic examination, triggers the TB treatment at district level hospitals within the developing setting of Southeast Asia, where culture is usually not included in the routine diagnosis algorithm [17]. Recently, the WHO-recommended TB diagnosis models were compared in HIV-infected TB suspects, in terms of cost effectiveness, to reduce the mortality within 6 months of antiretroviral therapy (ART) initiation [18]. The GeneXpert algorithm was found to be less costly than either smear-CXR or smear-CXR-culture algorithms.…”

“…The GeneXpert algorithm was found to be less costly than either smear-CXR or smear-CXR-culture algorithms. Culture and GeneXpert algorithms were more cost effective in reducing mortality than the current practice [18] (Table). This report represented a new diagnostic outline, skipping traditional diagnosis methods, which is likely to save time and resources.…”

Transforming TB Diagnosis: Can Patients and Control Programs Afford to Wait?

“…Other studies have found that Xpert *Address correspondence to Catharina C. Boehme, 16, Av de Budé , Geneva 1202. E-mail: Catharina.Boehme@finddiagnostics.org MTB/RIF testing was cost-effective for reducing premature mortality in patients with advanced HIV infection, both at the time of presentation with TB symptoms, 13 and before initiation of antiretroviral therapy.…”

Cost-effectiveness of Xpert MTB/RIF for tuberculosis diagnosis in South Africa: A real-world cost analysis and economic evaluation

“…Many model-based economic evaluations, [5][6][7] predicted that Xpert would be cost-effective, either through a reduction in tuberculosis-related mortality or reduction in the overtreatment of tuberculosis, or both, in a wide range of settings. Nevertheless, concerns over cost-effectiveness remained and the WHO guideline recommendation was conditional, explicitly acknowledging potential resource implications.…”