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. 2017 Sep 7;12(9):e0184270.
doi: 10.1371/journal.pone.0184270. eCollection 2017.

Scaling-up the Xpert MTB/RIF assay for the detection of tuberculosis and rifampicin resistance in India: An economic analysis

Sunil Khaparde  1 , Neeraj Raizada  2 , Sreenivas Achuthan Nair  3 , Claudia Denkinger  4 , Kuldeep Singh Sachdeva  1 , Chinnambedu Nainarappan Paramasivan  2 , Virender Singh Salhotra  5 , Anna Vassall  6   7 , Anja Van't Hoog  6
Affiliations

Scaling-up the Xpert MTB/RIF assay for the detection of tuberculosis and rifampicin resistance in India: An economic analysis

Sunil Khaparde et al. PLoS One. .

Abstract

Background: India is considering the scale-up of the Xpert MTB/RIF assay for detection of tuberculosis (TB) and rifampicin resistance. We conducted an economic analysis to estimate the costs of different strategies of Xpert implementation in India.

Methods: Using a decision analytical model, we compared four diagnostic strategies for TB patients: (i) sputum smear microscopy (SSM) only; (ii) Xpert as a replacement for the rapid diagnostic test currently used for SSM-positive patients at risk of drug resistance (i.e. line probe assay (LPA)); (iii) Upfront Xpert testing for patients at risk of drug resistance; and (iv) Xpert as a replacement for SSM for all patients.

Results: The total costs associated with diagnosis for 100,000 presumptive TB cases were: (i) US$ 619,042 for SSM-only; (ii) US$ 575,377 in the LPA replacement scenario; (iii) US$ 720,523 in the SSM replacement scenario; and (iv) US$ 1,639,643 in the Xpert-for-all scenario. Total cohort costs, including treatment costs, increased by 46% from the SSM-only to the Xpert-for-all strategy, largely due to the costs associated with second-line treatment of a higher number of rifampicin-resistant patients due to increased drug-resistant TB (DR-TB) case detection. The diagnostic costs for an estimated 7.64 million presumptive TB patients would comprise (i) 19%, (ii) 17%, (iii) 22% and (iv) 50% of the annual TB control budget. Mean total costs, expressed per DR-TB case initiated on treatment, were lowest in the Xpert-for-all scenario (US$ 11,099).

Conclusions: The Xpert-for-all strategy would result in the greatest increase of TB and DR-TB case detection, but would also have the highest associated costs. The strategy of using Xpert only for patients at risk for DR-TB would be more affordable, but would miss DR-TB cases and the cost per true DR-TB case detected would be higher compared to the Xpert-for-all strategy. As such expanded Xpert strategy would require significant increased TB control budget to ensure that increased case detection is followed by appropriate care.

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Conflict of interest statement

Competing Interests: I declare that NR, CD and CNP are employed by FIND, a non-profit organization that collaborates with industry partners, including Cepheid Inc., for the development and evaluation of new diagnostic tests. These partners with whom we have partnered have in no way contributed to the study and would not be benefited by the results of the study. As such this does not alter our adherence to PLOS ONE policies on sharing data and materials and there is no conflict of interest to the publication of this article.

Figures

Fig 1
Fig 1. Tornado diagram showing the effect of variation in each parameter value on total costs (US$ per patient tested) for the Xpert for all scenario.
See this image and copyright information in PMC

References

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