The Impact and Cost of Scaling up GeneXpert MTB/RIF in South Africa

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.

Diagnosing Xpert MTB/RIF negative TB: Impact and cost of alternative algorithms for South Africa

“…10 This populationlevel decision model estimates numbers of TB cases and costs for the financial years 2011 to 2016, with full-scale Xpert roll-out and implementation achieved in 2014. All results reported here are extrapolations for 2014.…”

Nationwide and regional incidence of microbiologically confirmed pulmonary tuberculosis in South Africa, 2004–12: a time series analysis

“…of tuberculosis cases diagnosed by 30-37%. 24 This period also intensifi ed case fi nding as part of the HIVtuberculosis campaign during 2010. Despite these changes, which would have increased the sensitivity for diagnosing cases of microbiologically confi rmed pulmonary tuberculosis in South Africa, incidence declined from 2008.…”

Connectivity of diagnostic technologies: improving surveillance and accelerating tuberculosis elimination

“…The coverage of Xpert varies considerably between countries, with some countries still having only a limited number of machines based in reference laboratories, and others, such as South Africa, that realised the advantages of implementing this novel platform as a first-line test fairly rapidly. 9 In the last 5 years, more than 13 million Xpert tests have been procured worldwide. When GeneXpert was rolled out in 2010, the instrument had no built-in connectivity outside basic standards, and the TB community did not have the software tools to connect to GeneXpert machines and use the data being generated to its full capacity.…”