Cost-effectiveness of Xpert MTB/RIF for TB diagnosis in South Africa: a real-world cost analysis and economic evaluation
Summary
Background
In 2010 a new diagnostic
test for tuberculosis, Xpert MTB/RIF, received a conditional
programmatic recommendation from WHO. Several model-based
economic evaluations predicted that Xpert would be
cost-effective across sub-Saharan Africa. We investigated the
cost-effectiveness of Xpert in the real world during national
roll-out in South Africa.
Methods
For this real-world cost
analysis and economic evaluation, we applied extensive primary
cost and patient event data from the XTEND study, a pragmatic
trial examining Xpert introduction for people investigated for
tuberculosis in 40 primary health facilities (20 clusters) in
South Africa enrolled between June 8, and Nov 16, 2012, to
estimate the costs and cost per disability-adjusted life-year
averted of introducing Xpert as the initial diagnostic test for
tuberculosis, compared with sputum smear microscopy (the
standard of care).
Findings
The mean total cost per
study participant for tuberculosis investigation and treatment
was US$312·58 (95% CI 252·46–372·70)
in the Xpert group and $298·58
(246·35–350·82) in the microscopy group. The
mean health service (provider) cost per study participant was
$168·79 (149·16–188·42) for the Xpert
group and $160·46 (143·24–177·68) for
the microscopy group of the study. Considering uncertainty in
both cost and effect using a wide range of willingness to pay
thresholds, we found less than 3% probability that Xpert
introduction improved the cost-effectiveness of tuberculosis
diagnostics.
Interpretation
After analysing
extensive primary data collection during roll-out, we found that
Xpert introduction in South Africa was cost-neutral, but found
no evidence that Xpert improved the cost-effectiveness of
tuberculosis diagnosis. Our study highlights the importance of
considering implementation constraints, when predicting and
evaluating the cost-effectiveness of new tuberculosis
diagnostics in South Africa.
Funding
Bill & Melinda Gates
Foundation.
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Source:
The Lancet Global Health
