Incremental cost-effectiveness of the second Xpert MTB/RIF assay to detect Mycobacterium tuberculosis

Wang, Guirong; Wang, Shuqi; Jiang, Guanglu; Fu, Yuhong; Shang, Yuanyuan; Huang, Hairong

doi:10.21037/jtd.2018.02.60

Cited by 14 publications

(15 citation statements)

References 18 publications

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“…Our study result demonstrated that GeneXpert testing among patients with suspected TB is very cost-effective. This cost estimate is in line with a study in China [32] and the United States [33] that found incorporating GeneXpert in the TB diagnostic algorithms was highly cost-effective.…”

Section: Discussionsupporting

confidence: 86%

Cost-effectiveness of GeneXpert Compared to Smear Microscopy for Diagnosis of Tuberculosis in Ethiopia

Kaso¹,

Hailu²

2020

Preprint

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Background Early diagnosis is one of the pillars of the TB (TB) control, and there are strong efforts to detect and treat cases in Ethiopia. Smear microscopy testing has been a routine test for the diagnosis of pulmonary TB in resource-constrained settings for a long time. Recently, many countries, including Ethiopia, are scaling up the use of GeneXpert without a precise evaluation of the cost and cost-effectiveness of this technology. Therefore, this study aimed to evaluate the cost-effectiveness of GeneXpert compared to smear microscopy tests for the diagnosis of TB patients in Ethiopia. Methods We develop a decision tree model using TreeAge Pro 2020 software. The model accounts for the prevalence and incidence of TB in the study area. The costs were estimated from the health providers' perspective in one year (in 2017/18). We applied an ingredients-based costing approach to identify, measure, and evaluate the smear microscopy cost and GeneXpert. We employed the 'proportion of cases detected' as an outcome measure of effectiveness. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the changes in cost and change effectiveness. One way and probabilistic sensitivity analysis were done by varying different input parameters. All costs and ICER are reported in 2018 US$. Results The unit cost per test for GeneXpert and smear microscopy testing was US$12.9 and $3.1, respectively. The average cost of testing using GeneXpert was $113.0 and $3.3 for smear microscopy. The cost of the cartridge ($10.7) was the primary (83%) parameter influencing the overall cost of GeneXpert, while it was the cost of reagent and consumables $1.28 (41%) for the smear microscopy. The ICER for GeneXpert strategy was $729.8 per new TB cases detected compared to smear microscopy. The sensitivity analysis indicates that TB prevalence was the most influential parameter on the ICER. Conclusion The present study indicates that testing all individuals with suspected TB using GeneXpert is a very cost-effective strategy compared to smear microscopy, and therefore, it can be part of the routine diagnostic testing strategy in Ethiopia.

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Section: Discussionsupporting

confidence: 86%

Cost-effectiveness of GeneXpert Compared to Smear Microscopy for Diagnosis of Tuberculosis in Ethiopia

Kaso¹,

Hailu²

2020

Preprint

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“…A utilização do teste em segunda amostra de um mesmo caso de tuberculose incrementa a detecção em 10,7% de casos de tuberculose extrapulmonar. Entretanto é válido salientar que o segundo teste resulta em considerável aumento dos recursos humanos e financeiros (Wang et al, 2018).…”

Section: Discussionunclassified

Desempenho do teste Xpert® MTB/RIF na detecção laboratorial de tuberculose em amostras pulmonares e extrapulmonares

Dietz¹,

Borges²,

Alves³

et al. 2021

RSD

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Objetivo: Avaliar a performance diagnóstica do Xpert® MTB/RIF na realidade goiana. Metodologia: Estudo transversal formulado a partir de registros arquivados na Seção de Micobactérias de um laboratório referência no diagnóstico de agravos de interesse em saúde pública do Estado de Goiás, Brasil. Foram coletados dados referentes a amostras vinculadas a casos suspeitos de tuberculose processadas no período compreendido entre outubro de 2017 e outubro de 2018. Incluiu-se no estudo amostras pulmonares e extrapulmonares que apresentavam resultados de Xpert® MTB/RIF e cultura. As informações coletadas foram utilizadas para composição de um banco de dados com as seguintes variáveis: espécime clínico, resultado do Xpert® MTB/RIF, resultado da cultura e tipo de cultura (sólida ou líquida). Para cálculo de sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN), o crescimento em cultura foi tido como referência. Resultados: Foram elegíveis para o estudo 3262 amostras, 3068 de origem pulmonar (94,1%) e 194 de origem extrapulmonar (5,9%). O Xpert® MTB/RIF mostrou sensibilidade e especificidade geral de 87,1% e 97,6% para amostras de origem pulmonar e 80,0% e 97,3% para amostras de origem extrapulmonar. O desempenho do teste variou de acordo com a amostra clínica e o tipo de cultura tomada como referência. Conclusão: O teste Xpert® MTB/RIF demonstrou no presente estudo ser uma importante ferramenta diagnóstica para casos de tuberculose tanto em amostras pulmonares quanto extrapulmonares, apresentando boa sensibilidade e especificidade. Os resultados, como de qualquer outra metodologia, devem ser interpretados com cautela e baseados na associação de critérios clínicos, epidemiológicos e laboratoriais.

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“…When cost and effectiveness data obtained from a trial are directly used to analyse the costs and clinical effects of a new intervention using standard statistical methods, this is regarded as a regression model or a trial-based analysis. Several studies examined cost effectiveness based upon (mostly) a single trial [24][25][26][27][28][29][30][31][32][33][34][35], without the use of a health-economic model. Four studies assessed diagnostics for general respiratory tract infections [24][25][26][27], two studies assessed diagnostics for pneumonia [28,30] and three assessed diagnostics for TB [29,31,32].…”

Section: Regression Models and Trial-based Analysesmentioning

confidence: 99%

“…Several studies examined cost effectiveness based upon (mostly) a single trial [24][25][26][27][28][29][30][31][32][33][34][35], without the use of a health-economic model. Four studies assessed diagnostics for general respiratory tract infections [24][25][26][27], two studies assessed diagnostics for pneumonia [28,30] and three assessed diagnostics for TB [29,31,32].…”

Section: Regression Models and Trial-based Analysesmentioning

confidence: 99%

“…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].…”

Section: Regression Models and Trial-based Analysesmentioning

confidence: 99%

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Economic Analyses of Respiratory Tract Infection Diagnostics: A Systematic Review

et al. 2021

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Background Diagnostic testing for respiratory tract infections is a tool to manage the current COVID-19 pandemic, as well as the rising incidence of antimicrobial resistance. At the same time, new European regulations for market entry of in vitro diagnostics, in the form of the in vitro diagnostic regulation, may lead to more clinical evidence supporting health-economic analyses. Objective The objective of this systematic review was to review the methods used in economic evaluations of applied diagnostic techniques, for all patients seeking care for infectious diseases of the respiratory tract (such as pneumonia, pulmonary tuberculosis, influenza, sinusitis, pharyngitis, sore throats and general respiratory tract infections). Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles from three large databases of scientific literature were included (Scopus, Web of Science and PubMed) for the period January 2000 to May 2020. Results A total of 70 economic analyses are included, most of which use decision tree modelling for diagnostic testing for respiratory tract infections in the community-care setting. Many studies do not incorporate a generally comparable clinical outcome in their cost-effectiveness analysis: fewer than half the studies (33/70) used generalisable outcomes such as qualityadjusted life-years. Other papers consider outcomes related to the accuracy of the test or outcomes related to the prescribed treatment. The time horizons of the studies generally are limited. Conclusions The methods to economically assess diagnostic tests for respiratory tract infections vary and would benefit from clear recommendations from policy makers on the assessed time horizon and outcomes used.Simon van der Pol and Paula Rojas Garcia contributed equally to the article.

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Incremental cost-effectiveness of the second Xpert MTB/RIF assay to detect Mycobacterium tuberculosis

Cited by 14 publications

References 18 publications

Cost-effectiveness of GeneXpert Compared to Smear Microscopy for Diagnosis of Tuberculosis in Ethiopia

Cost-effectiveness of GeneXpert Compared to Smear Microscopy for Diagnosis of Tuberculosis in Ethiopia

Desempenho do teste Xpert® MTB/RIF na detecção laboratorial de tuberculose em amostras pulmonares e extrapulmonares

Economic Analyses of Respiratory Tract Infection Diagnostics: A Systematic Review

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