Cost-effectiveness analysis of microscopic observation drug susceptibility test versus Xpert MTB/Rif test for diagnosis of pulmonary tuberculosis in HIV patients in Uganda
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Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Health Services Research
Abstract
Microscopic Observation Drug Susceptibility (MODS) and Xpert MTB/Rif (Xpert) are highly sensitive
tests for diagnosis of pulmonary tuberculosis (PTB). This study evaluated the cost effectiveness of utilizing MODS
versus Xpert for diagnosis of active pulmonary TB in HIV infected patients in Uganda.
Methods: A decision analysis model comparing MODS versus Xpert for TB diagnosis was used. Costs were
estimated by measuring and valuing relevant resources required to perform the MODS and Xpert tests. Diagnostic
accuracy data of the tests were obtained from systematic reviews involving HIV infected patients. We calculated
base values for unit costs and varied several assumptions to obtain the range estimates. Cost effectiveness was
expressed as costs per TB patient diagnosed for each of the two diagnostic strategies. Base case analysis was
performed using the base estimates for unit cost and diagnostic accuracy of the tests. Sensitivity analysis was
performed using a range of value estimates for resources, prevalence, number of tests and diagnostic accuracy.
Results: The unit cost of MODS was US$ 6.53 versus US$ 12.41 of Xpert. Consumables accounted for 59 %
(US$ 3.84 of 6.53) of the unit cost for MODS and 84 % (US$10.37 of 12.41) of the unit cost for Xpert. The cost
effectiveness ratio of the algorithm using MODS was US$ 34 per TB patient diagnosed compared to US$ 71 of
the algorithm using Xpert. The algorithm using MODS was more cost-effective compared to the algorithm
using Xpert for a wide range of different values of accuracy, cost and TB prevalence. The cost (threshold value),
where the algorithm using Xpert was optimal over the algorithm using MODS was US$ 5.92.
Conclusions: MODS versus Xpert was more cost-effective for the diagnosis of PTB among HIV patients in our
setting. Efforts to scale-up MODS therefore need to be explored. However, since other non-economic factors
may still favour the use of Xpert, the current cost of the Xpert cartridge still needs to be reduced further by
more than half, in order to make it economically competitive with MODS.
Description
Keywords
Cost-effectiveness, MODSXpert MTB/Rif, Diagnosis, Tuberculosis, HIV
Citation
Walusimbi, S., Kwesiga, B., Rodrigues, R., Haile, M., de Costa, A., Bogg, L., & Katamba, A. (2016). Cost-effectiveness analysis of microscopic observation drug susceptibility test versus Xpert MTB/Rif test for diagnosis of pulmonary tuberculosis in HIV patients in Uganda. BMC Health Services Research, 16(1), 1-10. DOI 10.1186/s12913-016-1804-9