Higher cost of implementing XpertW MTB/RIF in Ugandan peripheral settings: implications for cost-effectiveness
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Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
The international journal of tuberculosis and lung disease
Abstract
Initial cost-effectiveness evaluations of
Xpertw MTB/RIF for tuberculosis (TB) diagnosis have
not fully accounted for the realities of implementation in
peripheral settings.
OBJECTIVE : To evaluate costs and diagnostic outcomes
of Xpert testing implemented at various health care
levels in Uganda.
DESIGN: We collected empirical cost data from five
health centers utilizing Xpert for TB diagnosis, using an
ingredients approach. We reviewed laboratory and
patient records to assess outcomes at these sites and10
sites without Xpert.We also estimated incremental costeffectiveness
of Xpert testing; our primary outcome was
the incremental cost of Xpert testing per newly detected
TB case.
RESULT S : Themean unit cost of anXpert testwasUS$21
based on a mean monthly volume of 54 tests per site,
although unit cost varied widely (US$16–58) and was
primarily determined by testing volume. Total diagnostic
costs were 2.4-fold higher in Xpert clinics than in non-
Xpert clinics; however, Xpert only increased diagnoses by
12%. The diagnostic costs of Xpert averaged US$119 per
newly detectedTB case, butwere as high asUS$885 at the
center with the lowest volume of tests.
CONCLUS ION: Xpert testing can detect TB cases at
reasonable cost, but may double diagnostic budgets for
relatively small gains, with cost-effectiveness deteriorating
with lower testing volumes.
Description
Keywords
Tuberculosis, Diagnostic tests, Molecular diagnostic techniques, Cost-benefit analysis
Citation
Hsiang, E., Little, K. M., Haguma, P., Hanrahan, C. F., Katamba, A., Cattamanchi, A., ... & Dowdy, D. (2016). Higher cost of implementing Xpert® MTB/RIF in Ugandan peripheral settings: implications for cost-effectiveness. The international journal of tuberculosis and lung disease, 20(9), 1212-1218. http://dx.doi.org/10.5588/ijtld.16.0200