Cost minimization analysis of line probe assay for detection of multidrug-resistant tuberculosis in Arkhangelsk region of Russian Federation

Abstract

BackgroundThe development of new diagnostic tools allows for faster detection of both tuberculosis (TB) and multidrug-resistant (MDR) TB and should lead to reduced transmission by earlier initiation of anti TB therapy. The research conducted in the Arkhangelsk region of the Russian Federation in 2012–14 included economic evaluation of Line Probe Assay (LPA) implementation in MDR-TB diagnostics compared to existing culture-based diagnostics of Löwenstein Jensen (LJ) and BacTAlert. Clinical superiority of LPA was demonstrated and results were reported elsewhere.Study aimThe PROVE-IT Russia study aimed to report the outcomes of the cost minimization analysis.MethodsCosts of LPA-based diagnostic algorithm (smear positive (SSm+) and for smear negative (SSm-) culture confirmed TB patients by Bactec MGIT or LJ were compared with conventional culture-based algorithm (LJ–for SSm- and SSm+ patients and BacTAlert–for SSm+ patients). Cost minimization analysis was conducted from the healthcare system, patient and societal perspectives and included the direct and indirect costs to the healthcare system (microscopy and drug susceptibility test (DST), hospitalization, medications obtained from electronic medical records) and non-hospital direct costs (patient’s travel cost, additional expenses associated with hospitalization, supplementary medicine and food) collected at the baseline and two subsequent interviews using the WHO-approved questionnaire.ResultsOver the period of treatment the LPA-based diagnostic corresponded to lesser direct and indirect costs comparing to the alternative algorithms. For SSm+ LPA-based diagnostics resulted in the costs 4.5 times less (808.21 US$) than LJ (3593.81 US$) and 2.5 times less than BacTAlert liquid culture (2009.61 US$). For SSm- LPA in combination with Bactec MGIT (1480.75 US$) vs LJ (1785.83 US$) showed the highest cost minimization compared to LJ (2566.09 US$). One-way sensitivity analyses of the key parameters and threshold analyses were conducted and demonstrated that the results were robust to variations in the cost of hospitalization, medications and length of stay.ConclusionFrom the perspective of Russian Federation healthcare system, TB diagnostic algorithms incorporating LPA method proved to be both more clinically effective and less expensive due to reduction in the number of hospital days to the correct MDR-TB diagnosis and treatment initiation. LPA diagnostics comparing conventional culture diagnostic algorithm MDR-TB was a cost minimizing strategy for both patients and healthcare system.

Feasibility of Direct Sputum Molecular Testing for Drug Resistance as Part of Tuberculosis Clinical Trials Eligibility Screening

“…Indeed, the feasibility of rapid molecular testing on sputum samples has been associated with a median decrease in time of 25–66 days to appropriate treatment initiation in some programmatic settings [14,15]. Rapid molecular testing diagnostic algorithms have also been shown to correspond to as much as 4.5 times reduction in healthcare cost per patient when compared to phenotypic DST [16].…”

Economic Analyses of Respiratory Tract Infection Diagnostics: A Systematic Review

“…Cost-effectiveness acceptability curves (CEACs) were included in both articles [25,26], using the net benefit regression framework [36]. The reduction in antibiotic prescriptions was expressed in monetary terms 1 (50%) [87] 2 (29%) [89,90] (33%) [98] Middle income 5 (42%) [29,[32][33][34][35] 9 (20%) [38,43,55,58,64,71,75,79,84] 0 (0%) 2 (29%) [92,94] (67%) [96,97] Low income 1 (8%) [35] 5 (11%) [38,[44][45][46]83] 0 (0%) 1 (14%) [93] (33%) [98] as additional costs per patient prescription avoided [25] or additional costs per percentage reduction in antibiotic prescriptions [26]. Nicholson et al conducted a randomised controlled trial and health-economic evaluation of diagnostic tests for influenza, respiratory syncytial virus (RSV) and Streptococcus pneumoniae in adults hospitalised for chronic or acute cardiopulmonary illness in the UK [24].…”

“…Two studies presented a cost-effectiveness frontier to compare the different strategies included in the analysis [32,33]. The two studies assessing POC Xpert testing in South Africa had different conclusions compared with current care: cost saving [29] or cost effective (albeit more expensive) [31], while the study in the South African laboratory setting concluded that the higher costs were Note that not all items are reported by all articles; hence not all columns sum to the total included articles a Including a microsimulation [96] and two database studies [97,98] b According to World Bank definitions c Including sinusitis, pharyngitis, sore throat and general respiratory infections Cost-minimisation 0 (0%) 2 (4%) [54,65] 0 (0%) 0 (0%) 2 (67%) [97,98] a not matched by the improvement in TB diagnostic efficacy [34]. Wang et al concluded that the price increase related to performing a second Xpert test is relatively high [32].…”

“…Two CMAs used accounting data to study optimal healthcare resource use. Bogdanova et al compared two diagnostic algorithms for TB in Russia: a culture-based diagnostic algorithm and line probe assay to detect resistant TB, using costs collected from the government's accounting systems [97].The reduction in the number of hospital days to the correct diagnosis and treatment initiation were considered clinical outcomes. Oostenbrink et al [98] used hospital data to assess cost savings related to the implementation of a decision rule to diagnose and treat children with meningeal signs visiting a Dutch ED.…”

“…Both studies estimated and compared the resulting costs of each algorithm. One-way sensitivity analyses were included by changing the cost parameters of the model, and both studies concluded that the investigated strategy was cost saving compared with current care [97,98].…”