African Evaluation Database

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5823

Source

Scopus

Electronic ID

2-s2.0-84861674926

Authors

Meyer-Rath G., Schnippel K., Long L., MacLeod W., Sanne I., Stevens W., Pillay S., Pillay Y., Rosen S.

Title

The impact and cost of scaling up genexpert MTB/RIF in South Africa

Publication Year

2012

Source Title

PLoS ONE

Volume

Issue

Citations

DOI

10.1371/journal.pone.0036966

URL

https://www.scopus.com/inward/record.uri?eid=2-s2.0-84861674926&partnerID=40&md5=8ed69aa08904586ced38bb3bd36e52aa

Affiliations

Health Economics and Epidemiology Research Office (HE2RO), Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Center for Global Health and Development, Boston University, Boston, MA, United States; National Health Laboratory Service, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa; National Department of Health, Pretoria, South Africa

Authors with Affiliations

Meyer-Rath, G., Health Economics and Epidemiology Research Office (HE2RO), Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Center for Global Health and Development, Boston University, Boston, MA, United States; Schnippel, K., Health Economics and Epidemiology Research Office (HE2RO), Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Long, L., Health Economics and Epidemiology Research Office (HE2RO), Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; MacLeod, W., Health Economics and Epidemiology Research Office (HE2RO), Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Center for Global Health and Development, Boston University, Boston, MA, United States; Sanne, I., Health Economics and Epidemiology Research Office (HE2RO), Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Center for Global Health and Development, Boston University, Boston, MA, United States; Stevens, W., National Health Laboratory Service, Johannesburg, South Africa, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa; Pillay, S., National Health Laboratory Service, Johannesburg, South Africa, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Pillay, Y., National Department of Health, Pretoria, South Africa; Rosen, S., Health Economics and Epidemiology Research Office (HE2RO), Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Center for Global Health and Development, Boston University, Boston, MA, United States

Abstract

Objective: We 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. Methods: We 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. Results: At 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. Conclusion: Xpert 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. © 2012 Meyer-Rath et al.

Author Keywords

None

Index Keywords

ethambutol; ethionamide; isoniazid; kanamycin; ofloxacin; pyrazinamide; rifampicin; streptomycin; terizidone; rifampicin; analytical equipment; antimicrobial therapy; article; bacterium detection; classification algorithm; cohort analysis; controlled study; diagnostic test; follow up; growth rate; health care cost; human; lung tuberculosis; major clinical study; multidrug resistance; multidrug resistant tuberculosis; pilot study; population model; practice guideline; prevalence; scale up; South Africa; trend study; Xpert MTB RIF assay; antibiotic resistance; diagnostic test; economics; isolation and purification; lung tuberculosis; Mycobacterium tuberculosis; pathogenicity; statistics; time; Diagnostic Tests, Routine; Drug Resistance, Bacterial; Health Care Costs; Humans; Mycobacterium tuberculosis; Rifampin; South Africa; Time Factors; Tuberculosis, Pulmonary

Funding Details

None