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Microscopic observation drug‐susceptibility assay vs . Xpert ® MTB / RIF for the diagnosis of tuberculosis in a rural African setting: a cost–utility analysis
Author(s) -
WikmanJorgensen Philip E.,
LlenasGarcía Jara,
PérezPorcuna Tomàs M.,
Hobbins Michael,
Ehmer Jochen,
Mussa Manuel A.,
Ascaso Carlos
Publication year - 2017
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12879
Subject(s) - medicine , tuberculosis , per capita , environmental health , population , pathology
Objective To compare the cost–utility of microscopic observation drug‐susceptibility assay ( MODS ) and Xpert ® MTB / RIF implementation for tuberculosis ( TB ) diagnosis in rural northern Mozambique. Methods Stochastic transmission compartmental TB model from the healthcare provider perspective with parameter input from direct measurements, systematic literature reviews and expert opinion. MODS and Xpert ® MTB / RIF were evaluated as replacement test of smear microscopy ( SM ) or as an add‐on test after a negative SM . Costs were calculated in 2013 USD , effects in disability‐adjusted life years ( DALY ). Willingness to pay threshold ( WPT ) was established at once the per capita Gross National Income of Mozambique. Results MODS as an add‐on test to negative SM produced an incremental cost‐effectiveness ratio ( ICER ) of 5647.89 USD / DALY averted. MODS as a substitute for SM yielded an ICER of 5374.58 USD / DALY averted. Xpert ® MTB / RIF as an add‐on test to negative SM yielded ICER of 345.71 USD / DALY averted. Xpert ® MTB / RIF as a substitute for SM obtained an ICER of 122.13 USD / DALY averted. TB prevalence and risk of infection were the main factors impacting MODS and Xpert ® MTB / RIF ICER in the one‐way sensitivity analysis. In the probabilistic sensitivity analysis, Xpert ® MTB / RIF was most likely to have an ICER below the WPT , whereas MODS was not. Conclusion Our cost–utility analysis favours the implementation of Xpert ® MTB / RIF as a replacement of SM for all TB suspects in this rural high TB / HIV prevalence African setting.